Cardio-Oncology and Reverse Cardio-Oncology: the Manifold Interconnections Between Heart Failure and Cancer

This Research Topic is associated with the 36th meeting of the International Society for Heart Research – European Section, 29 June-2 July 2021, Turin (Italy). 

Although cardiovascular disease (CVD) and cancer have long been considered as two distinct entities, increasing evidence supports an intimate interconnection between these two conditions, with one predisposing to the other, with a continuous interplay. The recognition that cancer patients have significantly higher cardiovascular mortality risk than the general population, mostly because of the cardiotoxic side effects of anti-cancer treatments, prompted the development of the “Cardio-Oncology” discipline. The major goal of this branch of cardiology is to understand and tackle cancer therapy-related cardiotoxicity. A novel, exciting frontier of Cardio-Oncology is represented by the so-called “reverse Cardio-Oncology”, which aims at unraveling the mechanisms and the clinical implications behind cancer occurrence in patients with established CVD. This field of research has been stimulated by recent groundbreaking studies, overall converging on the provocative concept that heart failure (HF) implies a predisposition to cancer formation and/or progression. 

Over the last decades, Cardio-Oncology has shed light on the mechanisms by which widely used anti-cancer drugs, such as anthracyclines and anti-HER2 monoclonal antibodies, cause HF, and on the potential cardioprotective effects of molecules such as dexrazoxane. Nevertheless, the molecular events behind the cardiotoxicity of the next generation of oncological treatments, like immune check point inhibitors, are incompletely understood, and new anti-cancer therapies are marketed continuously. These limitations in knowledge prevent from finding specific and effective strategies to diagnose, prevent and treat HF secondary to cancer therapy-related cardiotoxicity. 

Furthermore, the nascent field of Reverse Cardio-oncology has just started to reveal the biological processes shared by cancer and HF, such as chronic systemic inflammation and clonal hematopoiesis of indeterminate potential. Breakthrough discoveries in this area are expected to pave the way towards repurposing of existing cardiovascular treatments to cure cancer, the use of antineoplastic agents to treat HF and/or the devise of next-generation therapies targeting cancer and HF simultaneously.

The purpose of this Research Topic is to address current challenges of Cardio-Oncology and Reverse Cardio-Oncology. Original Research Articles and Reviews focused on but not restricted to the following areas are encouraged:

1) Identification of shared mechanisms as well as common risk factors of cancer and HF

2) Development of powerful in vitro and in vivo models for the study of the interaction between cancer and HF as well as cardiotoxicity of oncological treatments, especially next generation drugs.

3) Dissecting the signaling pathways underlying the cardiotoxicity of most widely used as well as novel anti-cancer treatments

4) Understanding the role of intercellular cross-talks in the development of cardiotoxicity

5) Identification of new biomarkers and imaging technologies for early diagnosis of cardiotoxicity

6) Validating new preclinical approaches/molecules for cardioprotection and cancer prevention