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Cardio-Oncology: An Emerging Paradigm in Modern Medicine: 2nd Edition

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: 31 March 2026 | Viewed by 8856

Special Issue Editor


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Guest Editor
Section of Clinical Cardiology Robert and Suzanne Tomsich, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
Interests: cardio-oncology
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Special Issue Information

Dear Colleagues,

Tremendous strides have been made in improving oncological outcomes with innovation and dedicated research. However, the success has been marred by an increase in cardiovascular events in cancer patients. This is also overshadowed by the fact that cardiovascular disease (CVD) remains the number one cause of morbidity and mortality. While disease processes (cancer and heart disease) are independent causes of increased mortality, recent evidence suggests that they are intertwined. Therefore, the mitigation of risk factors from one (such as CVD) can protect patients from the other (such as cancer). In this Special Issue, our aim is to highlight the significant points of intersection between CVD and cancer. This will be achieved by discussing the major clinical implications regarding the prevention, diagnosis, management, and treatment of cardio-oncological diseases/syndromes. A salient aspect of the Issue will be the current state of the field and what the future holds for cardio-oncological patients. 

Cancer and cardiovascular disease are the two most common causes of death worldwide. As the fields of cardiovascular medicine and oncology continue to expand, the area of overlap is becoming more prominent, demanding dedicated attention and individualized patient care. We have come to realize that both fields are inextricably intertwined in several aspects, so much so that the mere presence of one, with its resultant downstream implications, has an impact on the other. Nonetheless, cardiovascular disease and cancer are generally approached independently. The focus that is granted to the predominant pathological entity (either cardiovascular disease or cancer) does not allow for optimal medical care for the other. As a result, ample opportunities for improvement in overall health care are being overlooked. Herein, we hope to shed light on the interconnected relationship between cardiovascular disease and cancer, and to uncover some of the unintentionally neglected intricacies of common cardiovascular therapeutics from an oncologic standpoint. 

We are pleased to invite you: 

  • To contribute to this one-of-a-kind Special Issue dedicated to discussing the past, present and, most importantly, future of this field. We would like to establish the current state of this field so that as we move forward, we have a clear picture of past research, a considerable understanding of today’s ongoing work, and a forecast of potential knowledge gaps and areas of interest to accelerate the advancement in cardio-oncology. 
  • This Special Issue aims to: 
  • Highlight the basic science of cardiotoxicity to cancer-related therapies.
  • Highlight clinical trials, research and studies that have shed light on the importance of and advancements in cardio-oncology.
  • Highlight social determinants, inequalities, and racial/ethnic disparities that still hinder the deployment of equitable care.
  • Enable future directions with the development of global registries and the deployment of artificial intelligence.

We look forward to receiving your contributions.

Dr. Rohit Moudgil
Guest Editor

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • cardio-oncology
  • CTRCD
  • arrhythmias
  • anthracyclines
  • anti-her2 therapies
  • immune checkpoint inhibitors
  • artificial intelligence
  • guidelines
  • emerging research

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Published Papers (6 papers)

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Research

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13 pages, 1000 KB  
Article
The Emerging Role of Left Atrial Strain in Cardiovascular Risk Stratification for Multiple Myeloma Patients Undergoing Carfilzomib Therapy
by Anna Colomba, Lorenzo Airale, Alice Lasagno, Giulia Mingrone, Anna Astarita, Fabrizio Vallelonga, Dario Leone, Martina Sanapo, Arianna Paladino, Francesca Novello, Sara Bringhen, Francesca Gay, Franco Veglio and Alberto Milan
Cancers 2025, 17(14), 2375; https://doi.org/10.3390/cancers17142375 - 17 Jul 2025
Viewed by 737
Abstract
Background: Carfilzomib (CFZ) is a proteasome inhibitor with known cardiotoxic effects used in multiple myeloma (MM) treatment. Cardio-oncology guidelines recommend cardiovascular risk assessment via echocardiography. Left atrial strain (LAS) is not yet included as a marker of cardiotoxicity, but it is emerging as [...] Read more.
Background: Carfilzomib (CFZ) is a proteasome inhibitor with known cardiotoxic effects used in multiple myeloma (MM) treatment. Cardio-oncology guidelines recommend cardiovascular risk assessment via echocardiography. Left atrial strain (LAS) is not yet included as a marker of cardiotoxicity, but it is emerging as a potential indicator of cardiac dysfunction. Objective: This study evaluates LAS as a predictor of CFZ-related hypertensive cardiovascular adverse events (CVAEs) in MM patients, with or without prior hypertension. Methods: A total of 125 MM patients treated with CFZ at the Hypertension Center, “Città della Salute e della Scienza” in Turin, were enrolled. Baseline assessments included transthoracic echocardiography for LAS analysis via Philips QLAB software. Results: During CFZ therapy, 52% of patients experienced hypertensive events. LAS conduit was significantly impaired in those who experienced CVAEs (−16.20 [−20.75; −12.65] vs. −20.80 [−26.30; −15.40], p = 0.006) and LAS conduit > −22 acted as a predictor of hypertensive adverse events in the normotensive population (OR 2.37 [1.02; 5.50]). Conclusion: These findings indicate that alterations in LAS conduit are linked to an increased risk of hypertensive adverse events during CFZ treatment. Incorporating LAS measurement into cardiovascular risk assessments may improve personalized risk stratification for MM patients, especially those without pre-existing hypertension. Full article
(This article belongs to the Special Issue Cardio-Oncology: An Emerging Paradigm in Modern Medicine: 2nd Edition)
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16 pages, 1070 KB  
Article
Validation of the HFA-ICOS Score for Carfilzomib-Induced Cardiotoxicity in Multiple Myeloma: A Real-Life Perspective Study
by Anna Astarita, Giulia Mingrone, Lorenzo Airale, Anna Colomba, Cinzia Catarinella, Marco Cesareo, Fabrizio Vallelonga, Arianna Paladino, Giulia Bruno, Dario Leone, Francesca Gay, Sara Bringhen, Franco Veglio and Alberto Milan
Cancers 2025, 17(14), 2353; https://doi.org/10.3390/cancers17142353 - 15 Jul 2025
Cited by 1 | Viewed by 1020
Abstract
Background: Despite the inference about the cardiotoxicity induced by Carfilzomib, no validated risk prediction models for adverse cardiovascular events in a real-life population are available. Objectives: The aim of this study was to evaluate the performance of the risk stratification score for Carfilzomib-induced [...] Read more.
Background: Despite the inference about the cardiotoxicity induced by Carfilzomib, no validated risk prediction models for adverse cardiovascular events in a real-life population are available. Objectives: The aim of this study was to evaluate the performance of the risk stratification score for Carfilzomib-induced cardiotoxicity of the Heart Failure Association of the European Society of Cardiology and the International Cardio-Oncology Society (HFA-ICOS) in patients with multiple myeloma (MM). Methods: This is a prospective, real-world study including MM patients consecutively enrolled prior to starting Carfilzomib, divided into levels of risk according to the HFA-ICOS proforma. Results: Of 169 patients, 11.8% were classified as ‘low risk’, 38.5% as ‘medium risk’, 45.6% as ‘high risk’ and 4.1% as ‘very high risk’ at baseline. A total of 89 (52.7%) patients experienced one of the following events: 36 (21.3%) had at least one cardiovascular event and 77 (45.6%) had almost one hypertension-related event. No significant differences were observed for the incidence of any cardiovascular events between the different levels of risk (p > 0.05), even considering the HFA-ICOS score as a continuous variable. The integration of the score with the baseline systolic blood pressure and pulse wave velocity enhanced the accuracy of the score (AUC 0.557 vs. 0.736). Conclusions: The HFA-ICOS score did not discriminate between patients at low, medium and high risk, showing a limited discriminatory power in predicting the risk of events in our population. The integration of other parameters in the HFA-ICOS score, such as systolic blood pressure and pulse wave velocity, improved the performance of the score. Full article
(This article belongs to the Special Issue Cardio-Oncology: An Emerging Paradigm in Modern Medicine: 2nd Edition)
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Review

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30 pages, 1853 KB  
Review
Risk Stratification for Cardiotoxicity in Childhood Cancer Survivors: State-of-the-Art Review and a Novel Two-Step Approach
by Fiorentina Guida, Marianna Fabi, Anna Balducci, Daniele Zama, Riccardo Masetti, Federico Mercolini, Tamara Belotti, Maria Elena Cantarini, Elena Facchini, Elena Lara Legnani, Fraia Melchionda, Ylenia Bartolacelli, Cristina Ciuca, Valentina Gesuete, Arcangelo Prete, Andrea Donti and Marcello Lanari
Cancers 2025, 17(23), 3740; https://doi.org/10.3390/cancers17233740 - 23 Nov 2025
Viewed by 331
Abstract
Numerous studies and international recommendations have investigated risk factors that put childhood cancer survivors (CCSs) at a higher risk of late-onset cancer therapy-related cardiovascular toxicities (CTR-CVTs). While anthracyclines and chest-directed radiotherapy are well-established high-risk treatments, other anticancer therapies, including alkylating agents, antimetabolites, targeted [...] Read more.
Numerous studies and international recommendations have investigated risk factors that put childhood cancer survivors (CCSs) at a higher risk of late-onset cancer therapy-related cardiovascular toxicities (CTR-CVTs). While anthracyclines and chest-directed radiotherapy are well-established high-risk treatments, other anticancer therapies, including alkylating agents, antimetabolites, targeted therapies, and hematopoietic stem cell transplantation, also carry potential cardiotoxic effects. The likelihood of developing CTR-CVT is further modulated by the presence of cardiometabolic risk factors, prior occurrence of CTR-CVT during treatment, and certain clinical conditions, which may predispose survivors to long-term cardiovascular complications. This state-of-the-art review summarizes current strategies for stratifying the risk for developing CTR-CVT in CCSs. We then propose a tailored, multimodal approach for guiding cardio-oncological assessments both during treatment and in long-term follow-up, including a structured echocardiographic protocol. Future perspectives include validation of this approach to optimize early detection and personalized management of CTR-CVT. Full article
(This article belongs to the Special Issue Cardio-Oncology: An Emerging Paradigm in Modern Medicine: 2nd Edition)
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44 pages, 1245 KB  
Review
In the Era of Cardiovascular–Kidney–Metabolic Syndrome in Cardio-Oncology: From Pathogenesis to Prevention and Therapy
by Vincenzo Quagliariello, Massimiliano Berretta, Irma Bisceglia, Ilaria Giacobbe, Martina Iovine, Matteo Barbato, Carlo Maurea, Maria Laura Canale, Andrea Paccone, Alessandro Inno, Marino Scherillo, Stefano Oliva, Christian Cadeddu Dessalvi, Alfredo Mauriello, Celeste Fonderico, Anna Chiara Maratea, Domenico Gabrielli and Nicola Maurea
Cancers 2025, 17(7), 1169; https://doi.org/10.3390/cancers17071169 - 30 Mar 2025
Cited by 7 | Viewed by 3362
Abstract
Cardiovascular–kidney–metabolic (CKM) syndrome represents a complex interplay between cardiovascular disease (CVD), chronic kidney disease (CKD), and metabolic disorders, significantly impacting cancer patients. The presence of CKM syndrome in cancer patients not only worsens their prognosis but also increases the risk of major adverse [...] Read more.
Cardiovascular–kidney–metabolic (CKM) syndrome represents a complex interplay between cardiovascular disease (CVD), chronic kidney disease (CKD), and metabolic disorders, significantly impacting cancer patients. The presence of CKM syndrome in cancer patients not only worsens their prognosis but also increases the risk of major adverse cardiovascular events (MACE), reduces quality of life (QoL), and affects overall survival (OS). Furthermore, several anticancer therapies, including anthracyclines, tyrosine kinase inhibitors, immune checkpoint inhibitors, and hormonal treatments, can exacerbate CKM syndrome by inducing cardiotoxicity, nephrotoxicity, and metabolic dysregulation. This review explores the pathophysiology of CKM syndrome in cancer patients and highlights emerging therapeutic strategies to mitigate its impact. We discuss the role of novel pharmacological interventions, including sodium-glucose cotransporter-2 inhibitors (SGLT2i), proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i), and soluble guanylate cyclase (sGC) activators, as well as dietary and lifestyle interventions. Optimizing the management of CKM syndrome in cancer patients is crucial to improving OS, enhancing QoL, and reducing MACE. By integrating cardiometabolic therapies into oncologic care, we can create a more comprehensive treatment approach that reduces the burden of cardiovascular and renal complications in this vulnerable population. Further research is needed to establish personalized strategies for CKM syndrome prevention and treatment in cancer patients. Full article
(This article belongs to the Special Issue Cardio-Oncology: An Emerging Paradigm in Modern Medicine: 2nd Edition)
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Other

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19 pages, 1897 KB  
Systematic Review
Unveiling the Mechanisms for the Development of Cardiotoxicity Following Chemotherapy Regimens Administration for Primary Colorectal Cancer: A Systematic Review
by Sophia Tsokkou, Ioannis Konstantinidis, Paraskevi Chatzikomnitsa, Menelaos Papakonstantinou, Evdokia Toutziari, Dimitrios Giakoustidis, Theodora Papamitsou, Vasileios Papadopoulos and Alexandros Giakoustidis
Cancers 2025, 17(19), 3129; https://doi.org/10.3390/cancers17193129 - 26 Sep 2025
Viewed by 919
Abstract
Background/Introduction: Colorectal carcinoma (CRC) belongs to the most commonly diagnosed malignancies to this date, ranking as third across the globe. In addition, CRC remains a leading cause of cancer-related deaths as it is ranked as the second most common cause of mortality. [...] Read more.
Background/Introduction: Colorectal carcinoma (CRC) belongs to the most commonly diagnosed malignancies to this date, ranking as third across the globe. In addition, CRC remains a leading cause of cancer-related deaths as it is ranked as the second most common cause of mortality. Therapeutic strategies for the management and treatment of CRC have made significant progress in the last two decades, with both adjuvant and neoadjuvant approaches playing critical roles in enhancing favorable outcomes with regimens like FOLFOX, CAPOX, and 5-FU-based therapies demonstrating effectiveness. Nevertheless, growing evidence indicates that these therapies may pose a risk of cardiotoxicity development. A systematic review will be conducted to map the mechanistic pathways of chemotherapy-induced in CRC in order to bridge oncology and cardiology perspectives, highlighting emerging diagnostic tools and long-term surveillance gaps. Purpose: The objective of this study is the investigation of the prevalence and characteristics of cardiovascular problems linked to frequently employed chemotherapy regimens, as well as to evaluate existing diagnostic and therapeutic approaches. Methodology: A thorough search across databases, including PubMed (MEDLINE), Embase, and Cochrane Library, was performed to locate articles published up to 2025. The final studies included in the review underwent quality assessment. Results: Fourteen qualifying studies, comprising both prospective trials and case reports from diverse geographies, were included. Cardiovascular outcomes including myocardial strain, arrhythmias, angina, heart failure, and Takotsubo cardiomyopathy were evaluated. The diagnostic methods assessed comprised echocardiography, cardiac biomarkers, and electrocardiograms. In the reviewed trials, chemotherapy-induced cardiotoxicity varied from asymptomatic ventricular strain to serious cardiac complications. The FOLFOX and 5-FU regimens were predominantly linked to adverse cardiac outcomes. Prompt identification by echocardiographic strain imaging and biomarker monitoring facilitated timely intervention. Case studies revealed that, given proper cardiological support, certain patients could safely recommence chemotherapy following recovery. No standardized cardiac screening protocol was identified among the trials. Conclusions: Chemotherapy for colorectal cancer may present considerable cardiovascular hazards, highlighting the necessity for routine cardiac monitoring prior to and throughout treatment. This systematic review promotes collaborative cardio-oncology strategies to reduce risk and enhance therapeutic safety. Full article
(This article belongs to the Special Issue Cardio-Oncology: An Emerging Paradigm in Modern Medicine: 2nd Edition)
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73 pages, 1799 KB  
Systematic Review
Determining Risk Factors Associated with Cardiovascular Complications in Patients with Acute Leukemia: A Systematic Review
by Arezoo Abasi, Haleh Ayatollahi, Soroush Rad and Marjan Hajahmadipoor Rafsanjani
Cancers 2025, 17(17), 2777; https://doi.org/10.3390/cancers17172777 - 26 Aug 2025
Viewed by 1842
Abstract
Background: Patients with acute leukemia (AL) are at heightened risk of cardiovascular complications due to both disease-related and treatment-related factors. These complications include heart failure, arrhythmias, myocardial infarction, and thromboembolic events which may significantly impact morbidity and mortality. Objective: To identify the risk [...] Read more.
Background: Patients with acute leukemia (AL) are at heightened risk of cardiovascular complications due to both disease-related and treatment-related factors. These complications include heart failure, arrhythmias, myocardial infarction, and thromboembolic events which may significantly impact morbidity and mortality. Objective: To identify the risk factors contributing to cardiovascular complications in patients with acute leukemia. Methods: This systematic review was conducted according to the PRISMA reporting guideline. Multiple databases including PubMed, Scopus, IEEE Xplore, the Cochrane Library, Web of Science, ProQuest, and Google Scholar were searched for studies published between 2020 and 2024. Eligible studies included those analyzing cardiovascular risk factors in AL patients across various subtypes and treatment stages. A total of 75 studies were included following rigorous screening and critical appraisal using tools appropriate for different study designs. Results: The results showed that cardiovascular complications in AL patients are multifactorial including demographic factors (e.g., age, sex, BMI), comorbidities (e.g., hypertension, diabetes, dyslipidemia), treatment exposures (e.g., anthracyclines, tyrosine kinase inhibitors, hematopoietic stem cell transplantation, radiation), and genetic predispositions (e.g., somatic and germline variants). Cardiac biomarkers (e.g., troponins, BNP), imaging (strain echocardiography), and electrocardiogram (ECG) abnormalities were key factors in detecting early or subclinical damage. Complications occurred both during and years after treatment, especially in childhood and long-term survivors. Conclusions: Cardiovascular complications are prevalent, and serious consequences in AL patients necessitate a personalized, multidisciplinary approach to risk stratification and monitoring. Considering clinical, genetic, and biomarker data can improve early detection and preventive strategies, ultimately enhancing patient outcomes. Full article
(This article belongs to the Special Issue Cardio-Oncology: An Emerging Paradigm in Modern Medicine: 2nd Edition)
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