Table 2.

List of targeted agents that cause cardiotoxicity

Serial No	Agent	Cardiotoxic Effect	Management	Reference
HER-2 Inhibitors
1.	Trastuzumab	LV Dysfunction/HF/HTN/Arrythmias	• LV Dysfunction-D/C agent, ACEI, and β-blocker	[2,42,43,54]
			• HF-D/C agent, ACEI, and β-blocker
			• HTN-ACEI and CCB
			• Arrhythmias-antiarrhythmics
2.	Pertuzumab	LV Dysfunction	• LV Dysfunction-D/C agent, ACEI, and β-blocker	[42,54]
Checkpoint Inhibitors
1.	Nivolumab	Myocarditis/Pericarditis/HF/Ventricular Arrhythmia	• Myocarditis-D/C agent, steroids	[5,43,48,55]
			• Pericarditis-D/C agent, pericardiocentesis
			• HF-D/C agent, ACEI, and β-blocker
			• Ventricular arrythmia-D/C agent, β-blocker; emergency defibrillation
2.	Ipilimumab	Myocarditis/Pericarditis/HF	• Myocarditis-D/C agent, steroids	[5,43,48,55]
			• Pericarditis-D/C agent, pericardiocentesis
			• HF-D/C agent, ACEI, and β-blocker
3.	Pembrolizumab	Myocarditis/HF	• Myocarditis-D/C agent, steroids	[5,43,55]
			• HF-D/C agent, ACEI, and β-blocker
4.	Atezolizumab	MI	• MI-D/C agent, PCI or IV thrombolytics as per AHA guidelines	[5,56]
5.	Avelumab	Myocarditis/HF/Ventricular arrythmia	• Myocarditis-D/C agent, steroids	[5,55]
			• HF-D/C agent, ACEI, and β-blocker
			• Ventricular arrythmia-D/C agent, β-blocker; emergency defibrillation
6.	Durvalumab	Myocarditis/HF/Ventricular arrythmia	• Myocarditis-D/C agent, steroids	[5,55]
			• HF-D/C agent, ACEI, and β-blocker
			• Ventricular arrythmia-D/C agent, β-blocker; emergency defibrillation
Small molecule TKIs and VEGF-inhibitors
1.	Sunitinib	HF/HTN/Thromboembolic events	• HF-D/C agent, ACEI, and β-blocker	[2,30,54,56]
			• HTN-ACEI and CCB
			• Thromboembolic Events-LMWH, edoxaban, or rivaroxaban
2.	Sorafenib	HTN/Thromboembolic events/LV dysfunction	• HTN-ACEI and CCB	[60,79]
			• Thromboembolic Events-LMWH, edoxaban, or rivaroxaban
			• LV dysfunction-D/C agent, ACEI, and β-blocker
3.	Regorafenib	HTN/Myocardial Ischemia	• HTN-ACEI and CCB	[58]
			• Myocardial ischemia-anticoagulation, aspirin, ADP receptor inhibitor
4.	Bevacizumab	HTN/HF/Thromboembolic events	• HTN-ACEI and CCB	[2,10,54,56]
			• HF-D/C agent, ACEI and β-blocker
			• Thromboembolic Events-LMWH, edoxaban, or rivaroxaban
5.	Imatinib	Thromboembolic events/HTN/HF	• Thromboembolic Events-LMWH, edoxaban, or rivaroxaban	[10,30,54,56]
			• HTN-ACEI and CCB
			• HF-D/C agent, ACEI and β-blocker
6.	Dasatinib	Thromboembolic events/HTN/HF	• Thromboembolic Events-LMWH, edoxaban, or rivaroxaban	[10,30,54,56]
			• HTN-ACEI and CCB
			• HF-D/C agent, ACEI and β-blocker
7.	Erlotinib	Thromboembolic events/HTN	• Thromboembolic Events-LMWH, edoxaban, or rivaroxaban	[30,54,56]
			• HTN-ACEI and CCB
8.	Nilotinib	Thromboembolic events/HTN/HF/Arrhythmias	• Thromboembolic Events-LMWH, edoxaban, or rivaroxaban	[10,30,54,56]
			• HTN-ACEI and CCB
			• HF-D/C agent, ACEI, and β-blocker
			• Arrhythmias-antiarrhythmics
9.	Ponatinib	HTN/HF/Thromboembolic Events	• Thromboembolic Events-LMWH, edoxaban, or rivaroxaban	[6,10,54,56]
			• HTN-ACEI and CCB
			• HF-D/C agent, ACEI, and β-blocker
10.	Lapatinib	HF/HTN/Arrhythmias	• HF-D/C agent, ACEI, and β-blocker	[10,54]
			• HTN-ACEI and CCB
			• Arrhythmias-antiarrhythmics
11.	Dabrafenib	Arrythmia	• Arrhythmias-antiarrhythmics	[56]
12.	Trametinib	HF	• HF-D/C agent, ACEI, and β-blocker	[56,61]
13.	Vemurafenib	HF	• HF-D/C agent, ACEI, and β-blocker	[62]
Proteasome Inhibitors
1.	Bortezomib	HF/Arrhythmias/HTN/MI	• HF-D/C agent, ACEI, and β-blocker	[2,10,66]
			• Arrhythmias-antiarrhythmics
			• HTN-ACEI and CCB
			• MI-PCI or IV thrombolytics as per AHA guidelines
2.	Carfilzomib	HF/Arrhythmias/Cardiomyopathy/HTN	• HF-D/C agent, ACEI, and β-blocker	[2,10,67]
			• Arrhythmias-antiarrhythmics
			• Cardiomyopathy-aspirin, statin, β-blocker
			• HTN-ACEI and CCB
3.	Ixazomib	HF	• HF-D/C agent, ACEI, and β-blocker	[68]
Other Targeted Agents and Immunomodulators
1.	CAR-T therapy	Arrhythmia/LV dysfunction/Hypotension/HF	• General-Tocilizumab, steroids if refractory	[6,75,78,80]
			• Arrhythmias-antiarrhythmics
			• LV dysfunction-ACEI and β-blocker
			• Hypotension-fluid replacement, vasopressors
			• HF-ACEI and β-blocker
2.	IL-2	Hypotension/Tachycardia/MI	• Hypotension-D/C agent, fluid replacement, vasopressors	[30,81]
			• Tachycardia-similar to hypotension
			• MI-PCI or IV thrombolytics as per AHA guidelines
3.	Interferon	MI/Tachyarrhythmia/HF	• MI-PCI or IV thrombolytics as per AHA guidelines	[10]
			• Tachyarrhythmia-antiarrhythmic
			• HF-D/C agent, ACEI, and β-blocker
4.	Thalidomide	Thromboembolism/MI/HF/Cardiogenic shock	• Thromboembolism-LMWH, edoxaban, or rivaroxaban	[10,56]
			• MI-PCI or IV thrombolytics as per AHA guidelines
			• HF-D/C agent, ACEI, and β-blocker
			• Cardiogenic shock-D/C agent, dobutamine, norepinephrine
4.	Lenalidomide	Similar to Thalidomide