Table 5.
Key recommendations for the screening and surveillance of cardiotoxicity during treatment for lung cancer (70).
| Treatment Class | Key Recommendations |
|---|---|
| Immune checkpoint inhibitors |
All patients:
• Check baseline ECG and biomarkers (BNP, cTn). • Monitor for symptoms/signs of myocarditis. *High-risk patients: • Consider checking baseline echo. • Repeat CV assessment every 6-12 months. |
| VEGF inhibitors |
All patients:
• Check BP at baseline and every clinical visit. • Regular HBPM during the first cycle, after each VEGFI dose increase, and every 2-3 weeks thereafter. For VEGFI at increased risk of QT prolongation (e.g. vandetanib, sorafenib, and sunitinib): • Check ECG monthly during the first 3 months and every 3-6 months thereafter. **High- and very high-risk patients: • Check baseline and serial echoes. |
| ALK or EGFR inhibitors |
All patients before starting Osimertinib:
• Check baseline echo. • Consider serial echo every 3 months. Patients treated with brigatinib, crizotinib, or lorlatinib: • Consider HBPM Patients on ALK inhibitor therapy: • Check ECG 4 weeks after starting therapy and every 3-6 months thereafter. |
| Anthracycline |
All patients:
• Check baseline echo. • Repeat echo within 12 months after completing therapy. **Moderate-risk patients: • Check echo after a cumulative dose of >250 mg/m2 of doxorubicin or equivalent. **High- and very high-risk patients: • Check echo every 2 cycles and within 3 months of treatment completion. • Check baseline BNP and cTn. • Check BNP and cTn before every cycle and 3 and 12 months after completing therapy. |
*Administration of dual ICI, combination ICI-cardiotoxic therapy, presence of noncardiac immune-related adverse events, prior cancer therapy-related cardiac dysfunction, or CVD (70).
**Risk based on Heart Failure Association-International Cardio-Oncology Society (HFA-ICOS) cardio-oncology cardiovascular risk assessment tool prior to cardiotoxic anticancer therapy (70, 91). This risk calculator includes the following data: previous history of CVD, cardiac biomarkers, age, cardiovascular risk factors, previous cardiotoxic treatment, and lifestyle risk factors.