How do we improve the long-term consequences of cardiotoxicity in survivors of childhood cancer?

Improvements in long-term childhood cancer survival are attributed to therapies with known cardiotoxic effects. Cardiovascular-related disease is the leading non-cancer-related cause of morbidity and mortality in these survivors. Many of these long-term survivors will develop traditional, modifiable risk factors related to aging, hereditary predisposition, or unhealthy lifestyle behaviors, which further increase their risk of having a cardiac event later in life. Evidence from several long-term, prospective, clinical trials have shown the persistent and progressive nature of anthracycline-induced cardiotoxicity in childhood cancer survivors. However, efforts to find effective primary prevention strategies in children are still ongoing, such as the promising use of the cardioprotectant dexrazoxane. Here we introduce the works presented in the second session of the International Colloquium on Cardio-oncology (Rome, March 12-14, 2014) entitled 'Cardiotoxicity in children, adolescents, and young adults'. Here, presenters addressed the advances and challenges in identifying, preventing, and treating the cardiac late-effects in childhood cancer survivors, and highlighted the long-term cardiovascular complications faced by adult survivors of childhood cancer. Validated cardiac monitoring and screening are now needed to identify early signs of cardiac dysfunction in high-risk childhood cancer patients who would benefit most from tailored,combined preventive measures. Ultimately, the goal is to prevent anthracycline-induced cardiotoxicity altogether without reducing oncologic efficacy.