Prevention and treatment of cardiomyopathy and heart failure in patients receiving cancer chemotherapy.

Chemotherapy (CT)-induced cardiotoxicity remains an unresolved problem that strongly affects the quality of life and overall survival of cancer patients. The most typical form of cardiotoxicity, a dilated cardiomyopathy (CMP), usually becomes manifest late in the course of the disease and is classically considered to be refractory to therapy. Preventing cardiotoxicity remains the most important strategy, and several measures have been proposed, including cardiac function monitoring, limitation of CT dose, use of anthracycline analogues and cardioprotectants, and early detection of cardiotoxicity by biomarkers. The response to modern heart failure therapy of CT-induced CMP has never been evaluated in clinical trials, and no definite guidelines have been adopted. Although it is likely that medications used for other forms of CMP, particularly angiotensin-converting enzyme inhibitors and beta-blockers, may be highly effective, there is still some unjustified concern regarding their use in cancer patients.