# Biomarker-guided cardioprotection for everyone on cardiotoxic cancer therapy

Source: https://onco.cc/ideas/idea-moon-cardioprotection-by-default/  
OnCo record `idea-moon-cardioprotection-by-default` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Anthracyclines, HER2 drugs and some newer agents can damage the heart. Monitor with blood tests and scans and start cheap heart-protective drugs early in those at risk.

## Summary

Cardio-oncology has grown as a specialty but access is patchy and protective strategies (dexrazoxane, statins, ACE inhibitors, beta-blockers, SGLT2 inhibitors) have mostly small or mixed trials. The proposal is a unified, algorithmic programme: baseline risk score, troponin and strain imaging surveillance at defined points, protocolised initiation of protective therapy on early signals, and a linked registry, tested in a pragmatic randomised trial across anthracycline, HER2 and immune checkpoint regimens.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Biomarker-guided cardioprotection halves the incidence of cancer therapy-related cardiac dysfunction at two years and reduces treatment interruptions for cardiac reasons.
- Rationale: Cardiac injury is detectable before it is symptomatic and several inexpensive drugs plausibly protect; the field lacks a standardised, tested pathway rather than candidate interventions.
- Proposed test: Pragmatic multi-centre trial randomising centres to the algorithmic programme versus usual care with cardiac dysfunction and oncology dose delivery as co-primary endpoints.
- Maturity: early-clinical
- Actor: research

## Sources

- Bottleneck evidence (Toxicity and quality of life are undervalued): Di Maio et al., Symptomatic toxicities experienced during anticancer treatment: agreement between patient and physician reporting (JCO 2015): https://doi.org/10.1200/JCO.2014.57.9334

## Connected records

- cancers: [Diffuse large B-cell lymphoma](https://onco.cc/cancers/dlbcl/), [HER2-positive breast cancer](https://onco.cc/cancers/breast-her2-positive/)
- technologies: [Cardio-oncology](https://onco.cc/technologies/cardio-oncology/), [Heart function after anthracyclines, trastuzumab and chest radiotherapy](https://onco.cc/technologies/cardiotoxicity-surveillance-recovery/), [Protecting the heart during anthracycline treatment: dexrazoxane, beta blockers and ACE inhibitors](https://onco.cc/technologies/anthracycline-cardioprotection/), [The heart after anthracyclines and chest radiotherapy in childhood](https://onco.cc/technologies/rejuv-paed-heart/)
- drugs: [Trastuzumab](https://onco.cc/drugs/trastuzumab/)
- bottlenecks: [Survivorship and late effects are neglected](https://onco.cc/bottlenecks/b-survivorship/), [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)
- key papers: [Symptomatic toxicities experienced during anticancer treatment: agreement between patient and physician reporting in three randomized trials](https://onco.cc/key-papers/paper-di-maio-j-clin-oncol/)
- roadmaps: [Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards](https://onco.cc/roadmaps/survivorship-roadmap/)

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