Innovations in pediatric cardio-oncology

Over the past 5decades, the diagnosis and management of children with various malignancies have improved tremendously. As a result, an increasing number of children are long-term cancer survivors. With improved survival, however, has come an increased risk of treatment-related cardiovascular complications that can appear decades later. Significant cardiac adverse effects occur due to radiation and chemotherapy received by patients treated for lymphoma. Treatment-related cardiac damage is irreversible and often progressive. A deeper understanding of the mechanisms of their cardiotoxicity reveals that there is no “safe” dose of anthracyclines. However, certain risk factors, such as higher lifetime anthracycline cumulative doses, higher anthracycline dose rates, longer follow-up, and cardiac irradiation, are associated with more severe cardiotoxicity. Identification of driver mutations causing these effects is an active innovative process, leading to personalized cancer therapy to limit cardiotoxic effects while ensuring an adequate antineoplastic effect. The further identification and implementation of these genetic susceptibilities would be truly innovative and ideal. In the meantime, it is imperative that such damage be prevented with strategies such as limiting the cumulative anthracycline dose, the use of anthracycline structural analogs, and the use of cardioprotective agents. Transition of care due to increasing survivor age is often abrupt and unplanned, and attrition rates are high. Multiple transitional care models exist but none are perfect. It is important for all pediatric and adult caregivers of childhood cancer survivors, including oncologists, cardiologists, and other healthcare personnel, to pay close attention to the short- and long-term effects of chemotherapy and radiotherapy in these children and work on collaboration to provide the best level of care.