Recommandations pour la pratique clinique Nice/Saint-Paul-de-Vence 2024–2025 : prise en charge cardio-oncologique des principaux schémas thérapeutiques en onco-gynécologie
New therapeutic options for gynecological cancers (in particular, targeted therapies and immunotherapies) are associated with potential cardiovascular toxicities that oncologists should be able to identify, detect and manage together with a cardiologist. The first step consists of evaluating the patient's individual cardiovascular risk, regardless of planned oncologic treatment, to determine whether this treatment can be initiated immediately or if cardiological advice is required. In a second step, the risk of cardiovascular toxicity of the selected treatment must be assessed, considering its intrinsic risk and the patient's comorbidities. Once treatment has started, appropriate monitoring should be implemented during administration, and after discontinuation. Beyond general recommendations, specific situations are detailed for initial workup and surveillance relating to most common protocols of chemotherapy, immunotherapy, targeted therapy and associations used in gynecological oncology. If cardiotoxicity occurs (hypertension, QT interval increase, left ventricular dysfunction, troponin increase, myocarditis), the oncologist must be aware of the principles of management, and distinguish between what he can manage on his own and what requires referring to specialists. Prior to rechallenge after cardiotoxicity, multidisciplinary discussion is mandatory to assess the patient's benefit/risk ratio.