Reading time: 7 minutes
Ludmila Peres Diaz, PhD
The human body is a highly coordinated biological machine that responds synchronously to a wide variety of internal and external stimuli. Therefore, if one part of the body is affected, other parts will be affected to some extent, either immediately or in the distant future.
If the brain is the captain of the ship, the heart is the chief engineer, responsible for all energetic and propulsion systems, and will do anything to keep the ship moving, even if that means sacrificing itself.
That is why the existence of a discipline called oncocardiology is not only logical but also necessary to adequately address the needs of cancer patients.
Not only to help them weather the most challenging storm and keep the ship afloat, but also to ensure the ship continues sailing for many more leagues.
What is oncocardiology?
This highly specialized medical discipline focuses on the identification, prevention, and treatment of cardiovascular complications arising from oncology and its therapies.
To see in advance all the issues that may arise with the ship’s engine room.
The introduction of new therapies triggering cardiovascular side effects and the fortunate increase in the number of long-term oncologic survivors have fueled the importance of this field.
Consequently, in recent years, there has been an increase in molecular research elucidating the links between drugs and cardiovascular disease, as well as in clinician and patient attention to this matter.
The concept of oncocardiology began to formalize after early reports of cardiotoxicity caused by anthracycline chemotherapy drugs during the 60’s and 70’s. However, it wasn’t until the early 2000s that the first dedicated “Oncocardiology Unit” was established at the University of Texas MD Anderson Cancer Center, followed by the founding of the International Cardioncology Society (ICOS) in 2009.
What is the primary focus of oncocardiology?
Oncocardiology aims to elucidate the mechanisms by which oncologic diseases and their treatments contribute to cardiovascular disease, to establish effective diagnostic methods, and to develop therapies that mitigate the cardiovascular burden in patients with oncologic diseases.
Particularly, selecting appropriate imaging techniques and accurately interpreting cardiovascular injuries resulting from oncological treatment can facilitate early detection, guide therapy, and improve patient outcomes. Early cardiotoxic effects are generally assessed with non-invasive imaging studies (echocardiography or multiple-gated acquisition scanning) and biomarker monitoring (troponin). Cardiac computed X-ray tomography (CT) scans are useful for evaluating structural abnormalities in the myocardium, coronary arteries, and aorta. Additionally, molecular imaging is crucial for understanding disease mechanisms and shaping future treatment strategies for cardiovascular issues. Cardiac MRI provides detailed tissue characterization of the myocardium. PET and SPECT imaging offer potential for quantitative analysis of cardiovascular diseases. Notably, FDG-PET is effective for concurrently assessing tumor response and detecting early cardiovascular involvement
If the ship needs to be reinforced to weather the storm, it is crucial to understand why and how the engine room could be affected (flooded or malfunctioning), what should be used to do it, and, most importantly, how the flood or malfunction can be mitigated as much as possible.
Traditionally, the field has focused on treating adverse effects, but there is growing recognition of its potential for prevention.
There are many ships, and many storms happen every day on the vast ocean of life. When that occurs, they are watched from the shore, guided and supported by those who swear to do so and those who love them. Many ships had been lost, and many lessons had been learned. It is now possible to foresee and be prepared.
Additionally, preclinical cardio-oncology research has expanded substantially, driven in part by the development of therapies that engage immunological pathways and the need to elucidate their underlying molecular mechanisms. These efforts have contributed to identifying potential cardioprotective targets and informed the development of combination strategies to mitigate cardiovascular toxicity during cancer treatment.
Oncological Therapies involved in Cardiovascular Disease
Oncology treatments can sometimes cause various heart-related issues. These occur through distinct molecular mechanisms that vary by therapy type. Some examples of these affected mechanisms include:
· Anthracyclines (e.g., Doxorubicin, Daunorubicin): These agents directly affect the integrity and function of crucial enzymes and proteins involved in cellular proliferation and DNA integrity maintenance or the prevention of toxic molecule formation.
The ship’s reinforcement causes structural damage to the core machinery.
· Immunological Therapy (e.g., Trastuzumab): The intended mechanism of action of the Anti-HER2 antibody for breast cancer is the inhibition of a molecular interaction involved in cardiac cell survival. Hence, this oncological drug has a high impact on cardiac integrity. Fortunately, emerging evidence suggests that most cardiovascular events occur asymptotically, are reversible, and do not require discontinuation of therapy. Early observation of cardiovascular injuries as a result of this therapy has led to protocol refinement, patient selection, and multidisciplinary collaboration to reduce cardiovascular adverse events.
The reinforcement allows water to enter the engines, corroding and damaging critical internal components, causing them to malfunction.
· Small Molecule Tyrosine Kinase Inhibitors (TKIs): These broad-spectrum agents inhibit the function of tyrosine kinases, which work as ON/OFF switches in cardiac cells. They are involved in the cell’s stress response, the prevention of dangerous blood clotting, and cardiac function.
The reinforcement triggers a combination of structural damage with water entering the engine room, and prevents the crew from maintaining the machinery’s functioning.
Broader Perspectives and “New Aspects”
Beyond the direct cardiotoxic effects of oncologic treatment, there’s a growing and exciting perspective in oncocardiology that highlights how closely connected oncology and cardiovascular diseases (CVDs) really are. It’s important to recognize that many oncologic patients either have or have had CVDs, and to explore the common risk factors that link them, such as lifestyle-related conditions like type II diabetes, dyslipidemia, hypertension, and obesity. Additionally, shared inflammatory mechanisms are believed to influence both areas, emphasizing the importance of a holistic approach to patient care conditions.
Many ships have already been navigating the ocean of life for many leagues. The ships are damaged, and the crew, although experienced and knowledgeable, is fatigued and overwhelmed. It is crucial that those on the shore embrace this idea before sending reinforcements, if they want to provide the best strategies for weathering the storm and beyond. Knowing what they have gives the crew power to face any adversity.
Current Challenges and Future Directions
The field faces challenges, including ongoing knowledge gaps among healthcare providers regarding oncologic therapy-related cardiotoxicity. Future efforts include conducting basic research that integrates cardiovascular assessments into oncological in vitro and in vivo models, and clinical trials that, for example, evaluate the long-term cardioprotective effects of cardiovascular drugs (e.g., ACE inhibitors or β-blockers), particularly in pediatric populations. Additionally, standardizing the recording of cardiovascular side effects in drug development, integrating oncocardiology into healthcare systems, and developing educational programs.
Those on the shore, particularly those making decisions, must have better communication equipment, training, support, and awareness of the storms and the ships to properly address engineering issues.
Additionally, personalized oncologic therapies that account for individual susceptibility to cardiotoxic effects based on genetic or molecular markers represent a promising opportunity for oncocardiologists.
Each storm is different, and each ship responds to reinforcement differently. Keeping fluid communication during and after the storm is fundamental to maintaining the vessel’s navigation.
Finally, effective oncocardiology requires close collaboration among cardiologists, oncologists, and other healthcare professionals, including nurses, pharmacists, and social workers.
For those about to face the most challenging storm, multidisciplinary teams are now accounting for all variables and formulating the best strategy to help them weather it and sail across the ocean for many, many sunsets more.
Together, we are stronger.
Header Image Source: https://freerangestock.com/photos/87318/ship-sailing-on-the-open-sea.html
Edited by Michael Marand
References
1. Yeh ET, Chang HM. Oncocardiology—past, present, and future: a review. JAMA Cardiol. 2016;1(9):1066-1072. doi:10.1001/jamacardio.2016.2132
2. Michel L, Schadendorf D, Rassaf T. Oncocardiology: new challenges, new opportunities. Herz. 2020;45(7):619-625. doi:10.1007/s00059-020-04951-x
3. Sueta D, Hokimoto S. Onco-cardiology: present and future. Int J Cardiol. 2016;215:38-40. doi:10.1016/j.ijcard.2016.04.074
4. Tamaki N, Manabe O, Hirata K. Cardiovascular imaging in cardio-oncology. Jpn J Radiol. 2024;42(12):1372-1380. doi:10.1007/s11604-024-01636-x
5. Mikail N, Chequer R, Imperiale A, et al. Tales from the future—nuclear cardio-oncology, from prediction to diagnosis and monitoring. Eur Heart J Cardiovasc Imaging. 2023;24(9):1129-1145. doi:10.1093/ehjci/jead168
6. Park CM, Lerman B, Yametti FC, et al. Cardio-oncology and multi-imaging modalities. J Clin Med. 2025;14(12):4353. doi:10.3390/jcm14124353
7. Pamungkas RP, Pratiwi L, Sutanto H. HER2-targeted therapies and cardiotoxicity: from major concern to manageable risk. Curr Probl Cardiol. 2025;50(10):103168. doi:10.1016/j.cpcardiol.2025.103168
8. Bonaca MP, Lang NN, Chen A, et al. Cardiovascular safety in oncology clinical trials: JACC: CardioOncology primer. JACC CardioOncol. 2025;7(2):270-281. doi:10.1016/j.jaccao.2025.01.005
9. Lyon AR, López-Fernández T, Couch LS, et al. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J. 2022;43(41):4229-4361. doi:10.1093/eurheartj/ehac244
10. Migliari M, Fazzini L, Campana N, Deidda M, Dessì M, Cadeddu Dessalvi C. Current strategies for prevention of cancer therapy-related cardiotoxicity: pharmacological, non-pharmacological and emerging approaches. Front Cardiovasc Med. 2025;12:1668308. doi:10.3389/fcvm.2025.1668308
OncoBites 
Leave a comment