PREVENTION OF CARDIOVASCULAR TOXICITY OF ANTITUMOR THERAPY IN PATIENTS WITH CHRONIC HEART FAILURE

Background. The presence of chronic heart failure in patients undergoing chemotherapy for cancer is a significant aggravating prognostic factor.

Objective: To analyze current literature on the risk of cardiotoxic effects during cancer chemotherapy, recommendations for their prevention in patients with chronic heart failure, and new opportunities to reduce the risk of developing and progressing cardiotoxic effects of chemotherapy.

Materials and Methods. A non-systematic review of domestic and international literature on the topic under study was conducted using a continuous subset of the Medical Literature Analysis and Retrieval System Online, Excerpta Medica Data Base, PubMed, Russian Science Citation Index, and eLibrary databases. The following keywords were used: arterial hypertension, ischemic heart disease, chronic heart failure, antitumor therapy, cardiotoxicity, prevention, and combinations thereof. A total of 105 sources were analyzed, 42 of which were used in the review. The search period spanned 10 years, from 2014 to 2024. The review also included sources with publication dates earlier than 2000 and 2004, as they provide valuable information on this topic.

Results. The risk of cardiovascular complications significantly increases in patients undergoing cancer chemotherapy and those with chronic heart failure. Prevention of complications involves a thorough assessment of the patient's profile, selection of anticancer drug, and dosage. A mandatory condition for the treatment of such patients is monitoring standard heart failure therapy (beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, statins). A new approach to preventing cardiotoxic effects in patients with chronic heart failure during anticancer therapy may be the use of a combination of sacubitril/valsartan and a selective, reversible inhibitor of sodium-glucose cotransporter type 2.

Conclusion. The widespread use of chemotherapy in the treatment of cancer requires a thorough, comprehensive approach to diagnostics to prevent acute cardiovascular events in patients with cardiovascular pathology, particularly heart failure. According to studies, the incidence of cardiotoxic effects remains high, likely due to the insufficient efficacy of existing cardiovascular prophylactic agents during chemotherapy. Of interest are studies examining the outcomes of chronic heart failure in patients receiving sacubitril/valsartan during breast cancer chemotherapy. Evaluating the effects of reversible sodium-glucose cotransporter-2 inhibitors is an important area of ​​research. Further research and the implementation of these findings in clinical practice are needed.

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