Looking beyond cancer for cabozantinib-induced cardiotoxicity: evidence of absence or absence of evidence?

The advent of molecular targeted therapy has transformed the scape of medical oncology in the past decades—patients previously deemed terminal now have more treatment options proven to extend survival. An example is renal cell carcinoma (RCC); given its myriad clinical presentation, a significant proportion of patients have locally advanced or metastatic disease at the time of diagnosis. Historically, treatment options for such patients were limited and their prognosis grim. In the past years, however, vascular endothelial growth factor (VEGF) inhibitors and tyrosine kinase inhibitors (TKIs), such as bevacizumab, sunitinib and pazopanib, have been shown to improve progression-free survival, although there have been increasing reports of drug cardiotoxicity including hypertension and heart failure (1-5). As a result, there is a growing need for better patient selection, prevention and monitoring of cardiotoxicity during treatment, as well as exploration of alternative safer agents.