Treatments & toxicities per cancer type

Breast Cancer

Anthracycline

Agent

Main oncologic / hematologic indications

Type of cardiotoxicity

Estimated risk

Doxorubicin (Adriamycin®, Caelyx® (pegylated liposomal)) Daunorubicin Epirubicin Idarubicin

Solid tumors:
breast cancer, ovarian cancer, lung cancer, gastrointestinal cancers, bone and soft-tissue sarcomas.

Hematologic malignancies:
Hodgkin and non-Hodgkin lymphoma, ALL, AML, multiple myeloma, neuroblastoma.

Dose-dependent, often irreversible myocardial damage.
Typically presents as dilated cardiomyopathy and HF.
Acute effects (rare): arrhythmias, transient LV dysfunction.
Pathophysiology: cardiomyocyte apoptosis, oxidative stress, topoisomerase IIβ inhibition, mitochondrial dysfunction.

Symptomatic CTRCD:

~1–5% at low–moderate cumulative doses.
Up to 5–20% or higher at high cumulative doses (e.g. doxorubicin >550 mg/m²).

Asymptomatic CTRCD:

20–40%

Mitoxantrone

Hematologic malignancies:
Acute myeloid leukemia (especially relapsed/refractory), non-Hodgkin lymphoma

Solid tumors:
metastatic castration-resistant prostate cancer.

Non-oncologic indications:
selected forms of multiple sclerosis.)

anthracycline-like myocardial injury:
Dose-dependent systolic dysfunction and HF.
Mechanistically similar to anthracyclines but less cardiotoxic per cumulative dose.

Generally lower than doxorubicin.
Commonly reported around 1–4% at standard cumulative doses.

Proposed Surveillance (ESC guidelines):

Of note: NTproBNP is not reimbursed in Belgium

Anthracycline equivalent dosis calculator: https://www.cancercalc.com/anthracycline.php

References

Henriksen, P. A. (2018). “Anthracycline cardiotoxicity: an update on mechanisms, monitoring and prevention.” Heart, 104(12), 971–977.
Lyon A et al (2022) 2022 ESCGuidelines on cardio-oncology developed in collaboration with the European HematologyAssociation(EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). European Heart Journal (2022) 43, 4229–4361 https://doi.org/10.1093/eurheartj/ehac244
https://www.cancer.gov/about-cancer/treatment/drugs/

Anti HER 2

Agent (commercial name)	Main oncologic indications	Type of cardiotoxicity	Estimated risk
Trastuzumab (Herceptin®)	HER2-positive (IHC 3+ or FISH+) breast cancer (early and metastatic). HER2-positive gastric, gastro-esophageal junction, and selected pulmonary cancers.	Predominantly LV systolic dysfunction (LVSD) Non–dose-dependent Often reversible after treatment interruption	Symptomatic CTRCD: 2–4% with anthracyclines <1% without anthracyclines Asymptomatic CTRCD: up to 10–15%
Pertuzumab (Perjeta®)	HER2-positive breast cancer (early and metastatic), in combination with trastuzumab and chemotherapy.
Trastuzumab emtansine (T-DM1) (Kadcyla®)	HER2-positive breast cancer in the (neo)adjuvant and metastatic setting after prior trastuzumab/taxane therapy.		LVEF decline: ~0.9% Symptomatic HF is uncommon
Trastuzumab deruxtecan (T-DXd) (Enhertu®)	HER2-positive metastatic breast cancer. HER2-low (IHC 2+, FISH−) and HER2 ultra-low (IHC 1+) metastatic breast cancer.		LVEF decline: ~4.2% Symptomatic HF is uncommon

Across all HER2-targeted therapies, the risk of cancer therapy–related cardiac dysfunction (CTRCD) is significantly increased when combined with or preceded by anthracycline therapy, emphasizing the importance of baseline cardiovascular risk stratification and cardiac monitoring.

Proposed Surveillance (ESC guidelines):

NTproBNP is not reimbursed in Belgium

References

Zamorano, J. L., et al. (2016). “2016 ESC Position Paper on cancer treatments and cardiovascular toxicity.” European Journal of Heart Failure, 19(1), 9–42.Lyon A et al (2022) 2022 ESCGuidelines on cardio-oncology developed in collaboration with the European HematologyAssociation(EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart Journal (2022) 43, 4229–4361 https://doi.org/10.1093/eurheartj/ehac244
Seth L, Bhave A, Kollapaneni S, et al. Cardiotoxic Effects of Antibody Drug Conjugates vs Standard Chemotherapy in ERBB2-Positive Advanced Breast Cancer: A Systematic Review and Meta-Analysis. JAMA Netw Open. 2025;8(11):e2540336. doi:10.1001/jamanetworkopen.2025.40336
Lyon A et al (2022) 2022 ESCGuidelines on cardio-oncology developed in collaboration with the European HematologyAssociation(EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). European Heart Journal (2022) 43, 4229–4361 https://doi.org/10.1093/eurheartj/ehac244
https://www.cancer.gov/about-cancer/treatment/drugs/

TKI Breast

Drug class / agents	Main oncologic indications	Type of cardiotoxicity	Approximate risk (agent-specific where relevant)
CDK4/6 inhibitors Ribociclib (Kisqali®), Palbociclib (Ibrance®), Abemaciclib (Verzenios®)	Hormone receptor–positive, HER2-negative locally advanced or metastatic breast cancer, in combination with endocrine therapy.	QT prolongation (predominantly ribociclib) Hypertension Heart failure (uncommon) Atrial fibrillation (reported in real-world data)	QT prolongation (ribociclib): QTc>480 ms ~15–20%, QTc>500 ms: ~3–5% Heart failure <2–3%. Hypertension: Palbociclib: ~10–15%, Abemaciclib: ~10–20% Atrial fibrillation <5%. VTE (abemaciclib): 2–5%.
PARP inhibitors (PARPi) Olaparib, Talazoparib	Germline BRCA1/2–mutated, HER2-negative breast cancer: High-risk early-stage (adjuvant olaparib) Metastatic disease	No consistent association with CTRCD, arrhythmias, or hypertension

In oncology patients, the Fridericia formula (QTcF = QT/RR¹ᐟ³) is preferred for QT correction because it reduces the overestimation of QT prolongation seen with Bazett’s formula — particularly at higher heart rates — and minimizes inappropriate management changes during QT-prolonging cancer therapy.

Proposed Surveillance for patients receiving CDK4/6i (ESC guidelines):

No cardiovascular surveillance is required for patients receiving PARPi

References

Park C, Liu YS, Kenawy AS, Lin YH, Liu Y, Heo JH. Cardiovascular Adverse Events and Associated Costs of CDK4/6 Inhibitors in Patients With Breast Cancer. J Natl Compr Canc Netw. 2025 Apr 18;23(5):e257001. doi: 10.6004/jnccn.2025.7001. PMID: 40250478.
Pavlovic D, Niciforovic D, Papic D, Milojevic K, Markovic M. CDK4/6 inhibitors: basics, pros, and major cons in breast cancer treatment with specific regard to cardiotoxicity – a narrative review. Ther Adv Med Oncol. 2023 Oct 11;15:17588359231205848.
Lyon A et al (2022) 2022 ESCGuidelines on cardio-oncology developed in collaboration with the European HematologyAssociation(EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS)
Palazzo A et al. Major adverse cardiac events and cardiovascular toxicity with PARP inhibitors-based therapy for solid tumors: a systematic review and safety meta-analysis. ESMO Open. 2023 Apr;8(2):101154. Eur Heart Journal (2022) 43, 4229–4361
Richardson DR et al. Association of QTc Formula With the Clinical Management of Patients With Cancer. JAMA Oncol.2022;8(11):1616–1623. doi:10.1001/jamaoncol.2022.4194

Prostate Cancer

Lung Cancer

Colon + GI Cancer

Antimetabolite

Agent	Main oncologic / hematologic indications	Type of cardiotoxicity	Estimated risk and risk factors
5-Fluorouracil (5-FU) Capecitabine	Gastrointestinal cancers: colorectal, gastric, pancreatic, esophageal cancer.Also used in (neo)adjuvant regimens for head and neck cancers.	Predominantly coronary vasospasm Angina, myocardial ischemia, myocardial infarction Atrial and ventricular arrhythmias	Any cardiac event: ~3–7% in most series (reported range 0.99–19.9%). Most frequent are ischemic events. Risk factors: pre-existing CAD, prior chest radiotherapy, renal insufficiency, dihydropyrimidine dehydrogenase (DPD) deficiency.
Cytarabine	Hematological indications: Acute myeloid leukemia (AML): induction and consolidation therapy. Other acute leukemias; Occasional use in lymphomas (e.g. intrathecal therapy).	Pericarditis Rare LV systolic dysfunction / cardiomyopathy	Pericarditis: <5%. Cardiomyopathy: rare, usually associated with high-dose regimens.
Methotrexate	Hematologic malignancies: Acute lymphocytic leukemia (ALL) (systemic and intrathecal), lymphomas (including primary CNS lymphoma). Solid tumors: osteosarcoma, head and neck cancers. Non-oncological indications: autoimmune disease and trophoblastic disease (low dose)	Pericarditis Rare LV systolic dysfunction / cardiomyopathy	Pericarditis / effusion: <5%, often dose-related. Cardiomyopathy: uncommon.

Proposed Surveillance for 5-Fluorouracil (5-FU) and Capecitabine (ESC guidelines):

No specific surveillance recommendations for cytarabine, methotrexate : consider surveillance strategies for other anticancer drugs that are given in combination.

References

Depetris I, Marino D, Bonzano A, Cagnazzo C, Filippi R, Aglietta M, Leone F. Fluoropyrimidine-induced cardiotoxicity. Crit Rev Oncol Hematol. 2018 Apr;124:1-10. doi: 10.1016/j.critrevonc.2018.02.002. Epub 2018 Feb 7. PMID: 29548480.
de Forni M, Armand JP. Cardiotoxicity of chemotherapy. Curr Opin Oncol. 1994 Jul;6(4):340-4. doi: 10.1097/00001622-199407000-00003. PMID: 7803534.
Weisfelner Bloom M et al. Cardio-Oncology and Heart Failure: a Scientific Statement From the Heart Failure Society of America. Journal of Cardiac Failure Volume 31, Issue 2 p 415-455February 2025

Angiogenesis INH

Drug class / agents

Main oncologic indications

Type of cardiotoxicity

Approximate risk

anti-VEGF monoclonal antibodies Bevacizumab (Avastin®)

Colorectal cancer, renal cell carcinoma,
NSCLC,
ovarian and cervical cancer,
selected primary brain tumors (e.g. meningioma).

Hypertension (most common)
Left ventricular dysfunction / heart failure
Arterial thromboembolic events (myocardial infarction, stroke)

Hypertension (all grades): 20–40% (Grade 3–4: 5–15%)
Heart failure: 1–4%

Vascular endothelial growth factor inhibitors VEGF (VEGFi)

Sunitinib (Sutent®)

Sorafenib (Nexavar®)

Pazopanib (Votrient®)

Axitinib (Inlyta®)

Lenvatinib (Lenvima®)

Cabozantinib (Cabometyx® / Cometriq®)

Regorafenib (Stivarga®)

Vandetanib (Caprelsa®)

Renal cell carcinoma,
hepatocellular carcinoma,
differentiated and medullary thyroid cancers,
GIST,
some other rare solid tumors depending on the specific agent.

Hypertension (very common)
LV dysfunction / heart failure

Hypertension (all grades): 20–70% (Grade 3–4: 10–20%)
Heart failure: 5–15% • Symptomatic CHF up to ~10–15% (higher with specific agents, eg. Sunitinib)
QT prolongation: 5–15%

Angiogenesis inhibitor related cardiovascular toxicities

Proposed Surveillance (ESC guidelines) :

NTproBNP is not reimbursed in Belgium

References

Touyz RM, Herrmann J. Cardiotoxicity with vascular endothelial growth factor inhibitor therapy. NPJ Precis Oncol. 2018 May 8;2:13. doi: 10.1038/s41698-018-0056-z. PMID: 30202791; PMCID: PMC5988734.
Lyon A et al (2022) 2022 ESCGuidelines on cardio-oncology developed in collaboration with the European HematologyAssociation(EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart Journal (2022) 43, 4229–4361 https://doi.org/10.1093/eurheartj/ehac244

Hepatobiliary Cancer

Angiogenesis INH

Drug class / agents

Main oncologic indications

Type of cardiotoxicity

Approximate risk

anti-VEGF monoclonal antibodies Bevacizumab (Avastin®)

Colorectal cancer, renal cell carcinoma,
NSCLC,
ovarian and cervical cancer,
selected primary brain tumors (e.g. meningioma).

Hypertension (most common)
Left ventricular dysfunction / heart failure
Arterial thromboembolic events (myocardial infarction, stroke)

Hypertension (all grades): 20–40% (Grade 3–4: 5–15%)
Heart failure: 1–4%

Vascular endothelial growth factor inhibitors VEGF (VEGFi)

Sunitinib (Sutent®)

Sorafenib (Nexavar®)

Pazopanib (Votrient®)

Axitinib (Inlyta®)

Lenvatinib (Lenvima®)

Cabozantinib (Cabometyx® / Cometriq®)

Regorafenib (Stivarga®)

Vandetanib (Caprelsa®)

Renal cell carcinoma,
hepatocellular carcinoma,
differentiated and medullary thyroid cancers,
GIST,
some other rare solid tumors depending on the specific agent.

Hypertension (very common)
LV dysfunction / heart failure

Hypertension (all grades): 20–70% (Grade 3–4: 10–20%)
Heart failure: 5–15% • Symptomatic CHF up to ~10–15% (higher with specific agents, eg. Sunitinib)
QT prolongation: 5–15%

Angiogenesis inhibitor related cardiovascular toxicities

Proposed Surveillance (ESC guidelines) :

NTproBNP is not reimbursed in Belgium

References

Touyz RM, Herrmann J. Cardiotoxicity with vascular endothelial growth factor inhibitor therapy. NPJ Precis Oncol. 2018 May 8;2:13. doi: 10.1038/s41698-018-0056-z. PMID: 30202791; PMCID: PMC5988734.
Lyon A et al (2022) 2022 ESCGuidelines on cardio-oncology developed in collaboration with the European HematologyAssociation(EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart Journal (2022) 43, 4229–4361 https://doi.org/10.1093/eurheartj/ehac244

Other Chemo

Alkylating agents

Agents	Main oncologic / hematologic indications	Type of Cardiotoxicity	Approximate risk & notes
Cyclophosphamide, Ifosfamide	Hematologic indications: Lymphomas (e.g. CHOP) Leukemias high-dose conditioning before autologous or allogeneic HSCT Solid tumors: breast and ovarian cancer, • bone and soft-tissue sarcomas.	Acute/subacute CTR-CVT: Myocarditis Pericarditis / pericardial effusion • Cardiomyopathy / heart failure	High-dose regimens (>120–150 mg/kg): cardiotoxicity ~8–20% (adults), ~5% (children). HF: reported <5% up to 10–29%. Onset typically 48 h to 10 days after exposure.
Cisplatin	Testicular, head & neck, lung, bladder, ovarian, and GI cancers (esophageal, gastric).	Myocardial ischemia / MI (most common) Arrhythmias Hypertension Rare cardiomyopathy / heart failure	Considered low in monotherapy, higher (1-6%) when combined with other cardiotoxic agents (e.g. 5-FU).
Busulfan, Carmustine, Mitomycin, Melphalan	Hematologic indications: HSCT conditioning (busulfan, melphalan, carmustine). Multiple myeloma (high-dose melphalan). Solid tumors: Selected solid tumors (mitomycin in GI, carmustine in CNS tumors).	Often in high-dose settings for stem cell transplantation: Veno-occlusive disease Rare cardiomyopathy • Pericardial effusion	Overall cardiac toxicity ~1–5% in transplant settings; data mainly from case series.

Surveillance:

No specific recommendations
Consider surveillance driven by co-administered cardiotoxic agents.
Refer to cardio-oncology for cyclophosphamide/ifosfamide in patients with known CVD, high CV risk, or planned high-dose therapy.

Antimicrotubule Agents – Taxanes and Vinca Alkaloids

Agents	Main indications	Type of Cardiotoxicity	Approximate risk
Taxanes Paclitaxel, Docetaxel, Cabazitaxel	Breast, ovarian, lung, prostate, head & neck, gastric and esophageal cancers.	Bradycardia(often asymptomatic and transient). Arrhythmias less commonly, conduction abnormalities, myocardial ischemia, or heart failure.	Bradycardia: ~5–30% (often asymptomatic). Arrhythmias: <5%.
Vinca alkaloids Vincristine, Vinblastine	ALL, Hodgkin and non-Hodgkin lymphomas, multiple myeloma, pediatric solid tumors.	Rarely myocardial ischemia/infarction, arrhythmias, or hypertension.	Low cardiotoxicity risk: Cardiac events <1–2%.

Surveillance:

No specific recommendations
Consider surveillance driven by co-administered cardiotoxic agents.

Other Anticancer Agents

Agents / Class	Main indications	Type of Cardiotoxicity	Approximate risk & notes
Arsenic trioxide	Acute promyelocytic leukemia (APL).	QT prolongation → torsades de pointes	QTc >470 ms: 20–30%. QTc >500 ms: 10–15%. TdP very rare (<1%) with monitoring.
Bleomycin	Hodgkin lymphoma, testicular and germ-cell tumors.	Rare myocardial ischemia, Raynaud phenomenon	<1–2% in preexisting cardiovascular disease or with combination therapy.
Interferon-α	Myeloproliferative neoplasms, hairy cell leukemia; historical use in CML, melanoma, RCC.	Arrhythmias, cardiomyopathy, heart failure, ischemia, hypertension	Cardiac events 5–15%; Heart failure <5%.
Tretinoin (ATRA)	APL (with arsenic or chemotherapy).	Not common, but can contribute to “differentiation syndrome” which may involve heart failure and pericardial effusion.	Differentiation syndrome with cardiac manifestations <5%.
Amsacrine	Relapsed/refractory AML.	Arrhythmias, QT prolongation; rare HF	Arrhythmias 5–10%; Heart failure <1%.
HDAC inhibitors Romidepsin, Vorinostat	Cutaneous and peripheral T-cell lymphomas.	QT prolongation, arrhythmias	QT prolongation: 10–20% (romipdesin) QTc >500 ms: ~1–5%.
Somatostatin analogs Lanreotide, Octreotide	Neuroendocrine tumors; hormonal symptom control.	Bradycardia (usually asymptomatic)	Bradycardia 5–15%, <1–2% clinically significant.

Surveillance:

No specific recommendations

References

Batra A, Patel B, Addison D, Baldassarre LA, Desai N, Weintraub N, Deswal A, Hussain Z, Brown SA, Ganatra S, Agarwala V, Parikh PM, Fradley M, Ghosh A, Guha A. Cardiovascular safety profile of taxanes and vinca alkaloids: 30 years FDA registry experience. Open Heart. 2021 Dec;8(2):e001849. doi: 10.1136/openhrt-2021-001849. PMID: 34952868; PMCID: PMC8710909.
National Cancer Institute. (2023). “Cardiovascular toxicities of targeted cancer therapies.” NCI Drug Information Summaries.
Oracle. (2025). “Does Lanreotide (Somatostatin analogue) cause bradycardia and is it dangerous?”.FDA Drug Label for Somatuline Depot (lanreotide).
Mondal P, Jain D, Aronow WS, Frishman WH. Cardiotoxicity of Cancer Therapies. Cardiol Rev. 2019 Sep/Oct;27(5):230-235. doi: 10.1097/CRD.0000000000000239. PMID: 30433897.
Weisfelner Bloom M et al. Cardio-Oncology and Heart Failure: a Scientific Statement From the Heart Failure Society of America. Journal of Cardiac Failure Volume 31, Issue 2 p 415-455February 2025
Lyon A et al (2022) 2022 ESCGuidelines on cardio-oncology developed in collaboration with the European HematologyAssociation(EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart Journal (2022) 43, 4229–4361 https://doi.org/10.1093/eurheartj/ehac244

Renal + Urinary tract Cancer

Angiogenesis INH

Drug class / agents

Main oncologic indications

Type of cardiotoxicity

Approximate risk

anti-VEGF monoclonal antibodies Bevacizumab (Avastin®)

Colorectal cancer, renal cell carcinoma,
NSCLC,
ovarian and cervical cancer,
selected primary brain tumors (e.g. meningioma).

Hypertension (most common)
Left ventricular dysfunction / heart failure
Arterial thromboembolic events (myocardial infarction, stroke)

Hypertension (all grades): 20–40% (Grade 3–4: 5–15%)
Heart failure: 1–4%

Vascular endothelial growth factor inhibitors VEGF (VEGFi)

Sunitinib (Sutent®)

Sorafenib (Nexavar®)

Pazopanib (Votrient®)

Axitinib (Inlyta®)

Lenvatinib (Lenvima®)

Cabozantinib (Cabometyx® / Cometriq®)

Regorafenib (Stivarga®)

Vandetanib (Caprelsa®)

Renal cell carcinoma,
hepatocellular carcinoma,
differentiated and medullary thyroid cancers,
GIST,
some other rare solid tumors depending on the specific agent.

Hypertension (very common)
LV dysfunction / heart failure

Hypertension (all grades): 20–70% (Grade 3–4: 10–20%)
Heart failure: 5–15% • Symptomatic CHF up to ~10–15% (higher with specific agents, eg. Sunitinib)
QT prolongation: 5–15%

Angiogenesis inhibitor related cardiovascular toxicities

Proposed Surveillance (ESC guidelines) :

NTproBNP is not reimbursed in Belgium

References

Touyz RM, Herrmann J. Cardiotoxicity with vascular endothelial growth factor inhibitor therapy. NPJ Precis Oncol. 2018 May 8;2:13. doi: 10.1038/s41698-018-0056-z. PMID: 30202791; PMCID: PMC5988734.
Lyon A et al (2022) 2022 ESCGuidelines on cardio-oncology developed in collaboration with the European HematologyAssociation(EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart Journal (2022) 43, 4229–4361 https://doi.org/10.1093/eurheartj/ehac244

Gynaecological Cancer

Angiogenesis INH

Drug class / agents

Main oncologic indications

Type of cardiotoxicity

Approximate risk

anti-VEGF monoclonal antibodies Bevacizumab (Avastin®)

Colorectal cancer, renal cell carcinoma,
NSCLC,
ovarian and cervical cancer,
selected primary brain tumors (e.g. meningioma).

Hypertension (most common)
Left ventricular dysfunction / heart failure
Arterial thromboembolic events (myocardial infarction, stroke)

Hypertension (all grades): 20–40% (Grade 3–4: 5–15%)
Heart failure: 1–4%

Vascular endothelial growth factor inhibitors VEGF (VEGFi)

Sunitinib (Sutent®)

Sorafenib (Nexavar®)

Pazopanib (Votrient®)

Axitinib (Inlyta®)

Lenvatinib (Lenvima®)

Cabozantinib (Cabometyx® / Cometriq®)

Regorafenib (Stivarga®)

Vandetanib (Caprelsa®)

Renal cell carcinoma,
hepatocellular carcinoma,
differentiated and medullary thyroid cancers,
GIST,
some other rare solid tumors depending on the specific agent.

Hypertension (very common)
LV dysfunction / heart failure

Hypertension (all grades): 20–70% (Grade 3–4: 10–20%)
Heart failure: 5–15% • Symptomatic CHF up to ~10–15% (higher with specific agents, eg. Sunitinib)
QT prolongation: 5–15%

Angiogenesis inhibitor related cardiovascular toxicities

Proposed Surveillance (ESC guidelines) :

NTproBNP is not reimbursed in Belgium

References

Touyz RM, Herrmann J. Cardiotoxicity with vascular endothelial growth factor inhibitor therapy. NPJ Precis Oncol. 2018 May 8;2:13. doi: 10.1038/s41698-018-0056-z. PMID: 30202791; PMCID: PMC5988734.
Lyon A et al (2022) 2022 ESCGuidelines on cardio-oncology developed in collaboration with the European HematologyAssociation(EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart Journal (2022) 43, 4229–4361 https://doi.org/10.1093/eurheartj/ehac244

Ent Cancer

Other Chemo

Alkylating agents

Agents	Main oncologic / hematologic indications	Type of Cardiotoxicity	Approximate risk & notes
Cyclophosphamide, Ifosfamide	Hematologic indications: Lymphomas (e.g. CHOP) Leukemias high-dose conditioning before autologous or allogeneic HSCT Solid tumors: breast and ovarian cancer, • bone and soft-tissue sarcomas.	Acute/subacute CTR-CVT: Myocarditis Pericarditis / pericardial effusion • Cardiomyopathy / heart failure	High-dose regimens (>120–150 mg/kg): cardiotoxicity ~8–20% (adults), ~5% (children). HF: reported <5% up to 10–29%. Onset typically 48 h to 10 days after exposure.
Cisplatin	Testicular, head & neck, lung, bladder, ovarian, and GI cancers (esophageal, gastric).	Myocardial ischemia / MI (most common) Arrhythmias Hypertension Rare cardiomyopathy / heart failure	Considered low in monotherapy, higher (1-6%) when combined with other cardiotoxic agents (e.g. 5-FU).
Busulfan, Carmustine, Mitomycin, Melphalan	Hematologic indications: HSCT conditioning (busulfan, melphalan, carmustine). Multiple myeloma (high-dose melphalan). Solid tumors: Selected solid tumors (mitomycin in GI, carmustine in CNS tumors).	Often in high-dose settings for stem cell transplantation: Veno-occlusive disease Rare cardiomyopathy • Pericardial effusion	Overall cardiac toxicity ~1–5% in transplant settings; data mainly from case series.

Surveillance:

No specific recommendations
Consider surveillance driven by co-administered cardiotoxic agents.
Refer to cardio-oncology for cyclophosphamide/ifosfamide in patients with known CVD, high CV risk, or planned high-dose therapy.

Antimicrotubule Agents – Taxanes and Vinca Alkaloids

Agents	Main indications	Type of Cardiotoxicity	Approximate risk
Taxanes Paclitaxel, Docetaxel, Cabazitaxel	Breast, ovarian, lung, prostate, head & neck, gastric and esophageal cancers.	Bradycardia(often asymptomatic and transient). Arrhythmias less commonly, conduction abnormalities, myocardial ischemia, or heart failure.	Bradycardia: ~5–30% (often asymptomatic). Arrhythmias: <5%.
Vinca alkaloids Vincristine, Vinblastine	ALL, Hodgkin and non-Hodgkin lymphomas, multiple myeloma, pediatric solid tumors.	Rarely myocardial ischemia/infarction, arrhythmias, or hypertension.	Low cardiotoxicity risk: Cardiac events <1–2%.

Surveillance:

No specific recommendations
Consider surveillance driven by co-administered cardiotoxic agents.

Other Anticancer Agents

Agents / Class	Main indications	Type of Cardiotoxicity	Approximate risk & notes
Arsenic trioxide	Acute promyelocytic leukemia (APL).	QT prolongation → torsades de pointes	QTc >470 ms: 20–30%. QTc >500 ms: 10–15%. TdP very rare (<1%) with monitoring.
Bleomycin	Hodgkin lymphoma, testicular and germ-cell tumors.	Rare myocardial ischemia, Raynaud phenomenon	<1–2% in preexisting cardiovascular disease or with combination therapy.
Interferon-α	Myeloproliferative neoplasms, hairy cell leukemia; historical use in CML, melanoma, RCC.	Arrhythmias, cardiomyopathy, heart failure, ischemia, hypertension	Cardiac events 5–15%; Heart failure <5%.
Tretinoin (ATRA)	APL (with arsenic or chemotherapy).	Not common, but can contribute to “differentiation syndrome” which may involve heart failure and pericardial effusion.	Differentiation syndrome with cardiac manifestations <5%.
Amsacrine	Relapsed/refractory AML.	Arrhythmias, QT prolongation; rare HF	Arrhythmias 5–10%; Heart failure <1%.
HDAC inhibitors Romidepsin, Vorinostat	Cutaneous and peripheral T-cell lymphomas.	QT prolongation, arrhythmias	QT prolongation: 10–20% (romipdesin) QTc >500 ms: ~1–5%.
Somatostatin analogs Lanreotide, Octreotide	Neuroendocrine tumors; hormonal symptom control.	Bradycardia (usually asymptomatic)	Bradycardia 5–15%, <1–2% clinically significant.

Surveillance:

No specific recommendations

References

Batra A, Patel B, Addison D, Baldassarre LA, Desai N, Weintraub N, Deswal A, Hussain Z, Brown SA, Ganatra S, Agarwala V, Parikh PM, Fradley M, Ghosh A, Guha A. Cardiovascular safety profile of taxanes and vinca alkaloids: 30 years FDA registry experience. Open Heart. 2021 Dec;8(2):e001849. doi: 10.1136/openhrt-2021-001849. PMID: 34952868; PMCID: PMC8710909.
National Cancer Institute. (2023). “Cardiovascular toxicities of targeted cancer therapies.” NCI Drug Information Summaries.
Oracle. (2025). “Does Lanreotide (Somatostatin analogue) cause bradycardia and is it dangerous?”.FDA Drug Label for Somatuline Depot (lanreotide).
Mondal P, Jain D, Aronow WS, Frishman WH. Cardiotoxicity of Cancer Therapies. Cardiol Rev. 2019 Sep/Oct;27(5):230-235. doi: 10.1097/CRD.0000000000000239. PMID: 30433897.
Weisfelner Bloom M et al. Cardio-Oncology and Heart Failure: a Scientific Statement From the Heart Failure Society of America. Journal of Cardiac Failure Volume 31, Issue 2 p 415-455February 2025
Lyon A et al (2022) 2022 ESCGuidelines on cardio-oncology developed in collaboration with the European HematologyAssociation(EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart Journal (2022) 43, 4229–4361 https://doi.org/10.1093/eurheartj/ehac244

Melanoma

TKI RAF / MEK

Drug class / agents

Main oncologic indications

Type of cardiotoxicity

Approximate risk

BRAF inhibitors (BRAFi) Vemurafenib (Zelboraf®)
Dabrafenib (Tafinlar®)
Encorafenib (Braftovi®)

MEK inhibitors (MEKi) Trametinib (Mekinist®)
Cobimetinib (Cotellic®)
Binimetinib (Mektovi®)
Selumetinib (Koselugo®)

BRAF-mutated unresectable or metastatic melanoma.
BRAF-mutated thyroid and colorectal cancers (often in combination regimens).
Selected rare tumours with MAPK-pathway activation, e.g. histiocytic disorders, paediatric low-grade gliomas; (drug-specific).

LV dysfunction with all BRAFi/MEKi combinations)
Arterial hypertension and pulmonary hypertension
Atrial fibrillation (BRAFi alone or combined with MEKi)
Myocardial infarction (rare)
QTc prolongation (specific to vemurafenib + cobimetinib)

LV dysfunction with all BRAFi/MEKi combinations)
Arterial hypertension and pulmonary hypertension
Atrial fibrillation (BRAFi alone or combined with MEKi)
Myocardial infarction (rare)
QTc prolongation (specific to vemurafenib + cobimetinib)

RAF/MEK inhibitor related cardiovascular toxicity

Proposed Surveillance (ESC guidelines):

Consider additional TTE 4 weeks after starting the therapy in high and very high risk patients, as most CTRCD with RAF/MEKi develop early.

References

Glen C et al. Mechanistic and Clinical Overview Cardiovascular Toxicity of BRAF and MEK Inhibitors: JACC: CardioOncology State-of-the-Art Review, JACC: CardioOncology, Volume 4, Issue 1, 2022,Pages 1-18,
Lyon A et al (2022) 2022 ESCGuidelines on cardio-oncology developed in collaboration with the European HematologyAssociation(EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart Journal (2022) 43, 4229–4361 https://doi.org/10.1093/eurheartj/ehac244

Other Chemo

Alkylating agents

Agents	Main oncologic / hematologic indications	Type of Cardiotoxicity	Approximate risk & notes
Cyclophosphamide, Ifosfamide	Hematologic indications: Lymphomas (e.g. CHOP) Leukemias high-dose conditioning before autologous or allogeneic HSCT Solid tumors: breast and ovarian cancer, • bone and soft-tissue sarcomas.	Acute/subacute CTR-CVT: Myocarditis Pericarditis / pericardial effusion • Cardiomyopathy / heart failure	High-dose regimens (>120–150 mg/kg): cardiotoxicity ~8–20% (adults), ~5% (children). HF: reported <5% up to 10–29%. Onset typically 48 h to 10 days after exposure.
Cisplatin	Testicular, head & neck, lung, bladder, ovarian, and GI cancers (esophageal, gastric).	Myocardial ischemia / MI (most common) Arrhythmias Hypertension Rare cardiomyopathy / heart failure	Considered low in monotherapy, higher (1-6%) when combined with other cardiotoxic agents (e.g. 5-FU).
Busulfan, Carmustine, Mitomycin, Melphalan	Hematologic indications: HSCT conditioning (busulfan, melphalan, carmustine). Multiple myeloma (high-dose melphalan). Solid tumors: Selected solid tumors (mitomycin in GI, carmustine in CNS tumors).	Often in high-dose settings for stem cell transplantation: Veno-occlusive disease Rare cardiomyopathy • Pericardial effusion	Overall cardiac toxicity ~1–5% in transplant settings; data mainly from case series.

Surveillance:

No specific recommendations
Consider surveillance driven by co-administered cardiotoxic agents.
Refer to cardio-oncology for cyclophosphamide/ifosfamide in patients with known CVD, high CV risk, or planned high-dose therapy.

Antimicrotubule Agents – Taxanes and Vinca Alkaloids

Agents	Main indications	Type of Cardiotoxicity	Approximate risk
Taxanes Paclitaxel, Docetaxel, Cabazitaxel	Breast, ovarian, lung, prostate, head & neck, gastric and esophageal cancers.	Bradycardia(often asymptomatic and transient). Arrhythmias less commonly, conduction abnormalities, myocardial ischemia, or heart failure.	Bradycardia: ~5–30% (often asymptomatic). Arrhythmias: <5%.
Vinca alkaloids Vincristine, Vinblastine	ALL, Hodgkin and non-Hodgkin lymphomas, multiple myeloma, pediatric solid tumors.	Rarely myocardial ischemia/infarction, arrhythmias, or hypertension.	Low cardiotoxicity risk: Cardiac events <1–2%.

Surveillance:

No specific recommendations
Consider surveillance driven by co-administered cardiotoxic agents.

Other Anticancer Agents

Agents / Class	Main indications	Type of Cardiotoxicity	Approximate risk & notes
Arsenic trioxide	Acute promyelocytic leukemia (APL).	QT prolongation → torsades de pointes	QTc >470 ms: 20–30%. QTc >500 ms: 10–15%. TdP very rare (<1%) with monitoring.
Bleomycin	Hodgkin lymphoma, testicular and germ-cell tumors.	Rare myocardial ischemia, Raynaud phenomenon	<1–2% in preexisting cardiovascular disease or with combination therapy.
Interferon-α	Myeloproliferative neoplasms, hairy cell leukemia; historical use in CML, melanoma, RCC.	Arrhythmias, cardiomyopathy, heart failure, ischemia, hypertension	Cardiac events 5–15%; Heart failure <5%.
Tretinoin (ATRA)	APL (with arsenic or chemotherapy).	Not common, but can contribute to “differentiation syndrome” which may involve heart failure and pericardial effusion.	Differentiation syndrome with cardiac manifestations <5%.
Amsacrine	Relapsed/refractory AML.	Arrhythmias, QT prolongation; rare HF	Arrhythmias 5–10%; Heart failure <1%.
HDAC inhibitors Romidepsin, Vorinostat	Cutaneous and peripheral T-cell lymphomas.	QT prolongation, arrhythmias	QT prolongation: 10–20% (romipdesin) QTc >500 ms: ~1–5%.
Somatostatin analogs Lanreotide, Octreotide	Neuroendocrine tumors; hormonal symptom control.	Bradycardia (usually asymptomatic)	Bradycardia 5–15%, <1–2% clinically significant.

Surveillance:

No specific recommendations

References

Batra A, Patel B, Addison D, Baldassarre LA, Desai N, Weintraub N, Deswal A, Hussain Z, Brown SA, Ganatra S, Agarwala V, Parikh PM, Fradley M, Ghosh A, Guha A. Cardiovascular safety profile of taxanes and vinca alkaloids: 30 years FDA registry experience. Open Heart. 2021 Dec;8(2):e001849. doi: 10.1136/openhrt-2021-001849. PMID: 34952868; PMCID: PMC8710909.
National Cancer Institute. (2023). “Cardiovascular toxicities of targeted cancer therapies.” NCI Drug Information Summaries.
Oracle. (2025). “Does Lanreotide (Somatostatin analogue) cause bradycardia and is it dangerous?”.FDA Drug Label for Somatuline Depot (lanreotide).
Mondal P, Jain D, Aronow WS, Frishman WH. Cardiotoxicity of Cancer Therapies. Cardiol Rev. 2019 Sep/Oct;27(5):230-235. doi: 10.1097/CRD.0000000000000239. PMID: 30433897.
Weisfelner Bloom M et al. Cardio-Oncology and Heart Failure: a Scientific Statement From the Heart Failure Society of America. Journal of Cardiac Failure Volume 31, Issue 2 p 415-455February 2025
Lyon A et al (2022) 2022 ESCGuidelines on cardio-oncology developed in collaboration with the European HematologyAssociation(EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart Journal (2022) 43, 4229–4361 https://doi.org/10.1093/eurheartj/ehac244

Treatments & toxicities per cancer type

Contact