ABSTRACT

As the field of cardio-oncology evolves, the focus of treatment has shifted from reactive to proactive care. Prevention of cancer therapy-related cardiac dysfunction through optimization of cardiac risk factors and periodic surveillance, as well as minimal interruption of cancer treatment, is the emphasis of modern treatment paradigms.¹ Cardio-protection frequently involves the initiation of cardiac medications, including certain beta-blockers, angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin-receptor blockers (ARBs), and statins. Similarly, patients with pre-existing cardiac diseases are often prescribed a number of medications, such as anticoagulants and antiarrhythmics, that have potential and real interactions with a variety of chemotherapies. Because the therapeutic window for most chemotherapies is narrow, special attention should be given to these drug-drug interactions that may increase or decrease chemotherapeutic efficacy or predispose patients to serious unintended side effects. These drug-drug interactions are quite prevalent in the cancer population; one study determined that 16% of patients receiving oral anticancer drugs had at least one major drug-drug interaction that could cause harmful adverse effects.² Health care providers should be aware of potential drug-drug interactions and mitigate risks as they manage cardiovascular health in the context of cancer treatment. In the following review of drug-drug interactions involving chemotherapeutic and common cardiac medications, areas of focus include typical pharmacokinetic (PK) and pharmacodynamic (PD) interactions, antithrombotics, and QT prolongation.