Cardiotoxicity of chemotherapy.

With the use of hematologic support (colony stimulating factors and autologous bone marrow transplantation) for the control of chemotherapy-induced myelosuppression, more intensive strategies have been developed using higher doses, multidrug combinations, or more prolonged treatments. As a consequence of this approach, nonhematologic toxicities are more frequently dose-limiting and among them cardiotoxicity is of special concern. The spectrum of drugs associated with significant cardiotoxicity is extending, and each drug incriminated has its own cardiotoxicity profile. Various directions have been explored in experimental and clinical research for a better understanding of the physiopathology of drug-induced cardiotoxicity and the clinical characterization of agents involved in order to accurately assess risk factors and to preclude or overcome cardiotoxicity by means of cardioprotective agents or other means. The recent developments surrounding anthracyline or 5-fluorouracil cardiotoxicity are remarkable examples of these different strategies.