Title : Theranostic advances in cardio-oncology: Integrating precision diagnostics and targeted therapies for cardiovascular protection in cancer patients
Abstract:
The burgeoning field of cardio-oncology addresses the dual challenge of optimizing cancer treatment efficacy while mitigating cardiovascular toxicity - a critical concern as cancer survivorship rates rise. Recent theranostic advances, which synergize diagnostic precision and therapeutic intervention, are revolutionizing the management of cancer therapy-related cardiovascular toxicity (CTR-CVT). This review highlights cutting-edge strategies leveraging multimodal imaging, biomarker-driven algorithms, and targeted therapies to predict, detect, and treat cardiovascular complications in real time, thereby enhancing patient outcomes.
Advances in non-invasive imaging modalities, such as strain echocardiography, cardiac magnetic resonance (CMR) with T1/T2 mapping, and PET-CT with novel radiotracers (e.g., 68Ga-FAPI for fibroblast activation), enable early detection of subclinical myocardial injury, vascular dysfunction, and fibrosis. Concurrently, biomarkers like high-sensitivity troponin, NT-proBNP, and circulating tumor DNA (ctDNA) are being integrated into dynamic risk-prediction models to stratify patients for preemptive cardioprotection. For instance, the CARDIOTOX and PREDICT trials validated the utility of global longitudinal strain (GLS) and troponin-guided dexrazoxane administration in anthracycline-treated patients, reducing heart failure incidence by 40%.
Therapeutically, targeted agents such as sacubitril/valsartan, SGLT2 inhibitors, and immunomodulators (e.g., anakinra for myocarditis) are being repurposed to counteract specific pathways of CTR-CVT, including oxidative stress, endothelial dysfunction, and immune checkpoint inhibitor-induced myocarditis. Nanotechnology-driven drug delivery systems, such as liposomal doxorubicin with embedded cardioprotective miRNAs, exemplify theranostic innovation by minimizing off-target cardiac damage. Furthermore, AI-driven platforms now synthesize multi-omics data (genomic, proteomic, imaging) to personalize therapy schedules and predict cardiotoxicity trajectories.
Despite progress, challenges persist in standardizing protocols, validating biomarkers across diverse populations, and ensuring equitable access to advanced theranostic tools. Future directions emphasize hybrid imaging-AI pipelines, CRISPR-based cardioprotective gene editing, and collaborative cardio-oncology registries to refine risk-benefit paradigms. By bridging oncology and cardiology through precision theranostics, this multidisciplinary approach promises to safeguard cardiovascular health without compromising oncological outcomes, heralding a new era of survivorship care.
Keywords: Theranostics, Cardio-Oncology, Cardiovascular Toxicity, Precision Medicine, Biomarkers, AI-Driven Prediction.
