Drug attrition during pre-clinical and clinical development : understanding and managing drug-induced cardiotoxicity

Cardiovascular toxicity remains a major cause of concern during preclinical and clinical development as well as contributing to post-approval withdrawal of medicines. This issue is particularly relevant for anticancer drugs where, the significant improvement in the life
expectancies of patients has dramatically extended the use and duration of drug therapies.
Nevertheless, cardiotoxicity is also observed with other classes of drugs, including antibiotics, antidepressants, and antipsychotics. This article summarizes the clinical manifestations of druginduced cardiotoxicity by various cancer chemotherapies and novel drugs for the treatment of other diseases. Furthermore, it presents on overview of biomarker and imaging techniques for the
detection of drug-induced cardiotoxicity. Guidelines for the management of patients exposed to drugs with cardiotoxic potential are presented as well as a checklist for collecting information
when a safety signal is observed in clinical trials to more effectively assess the risk of cardiotoxicity
and manage patient safety.