Moving Beyond Cardiotoxicity Detection to Prevention: A Pharmacologic Review

Cardio-oncology is a subspecialty of medicine focused on minimizing the risk of cardiovascular (CV) toxicity in patients receiving potentially cardiotoxic cancer therapy. While the literature has previously focused on detection of CV toxicity, there has been growing interest in primary prevention strategies for cancer therapy-related cardiovascular toxicity (CTR-CVT).

Several trials have investigated the role of angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and/or beta-blockers with mixed results, prompting researchers to assess alternatives, e.g., statins and sodium-glucose co-transporter-2 inhibitors (SGLT-2i). In this review, we discuss the positive and negative clinical trial results relating to these two drug classes. Ongoing prevention-focused clinical trials include ARBs in combination with neprilysin inhibitors (ARNis), azeliragon, and ivabradine. Further research is needed to discern the true benefit of novel agents and, importantly, the specific populations that would derive the most benefit.

In this review, we focus on results from recently reported studies exploring the potential benefit of pharmacologic approaches in primary prevention. There are currently no definitive signals strongly recommending a specific class of drugs for primary prevention in patients with cancer. Further research is required to determine which subset of patients might benefit from primary prevention strategies.