Forward and Reverse Cardio-oncology

What is the difference between forward and reverse cardio-oncology? In our latest episode, Deputy Editor Dr. Carol Ann Remme (University of Amsterdam) interviews Dr. Rudolf de Boer (Erasmus Medical Center) about the new Review article by Meijers et al. Forward cardio-oncology focuses on cardiotoxicity and cardiac damage due to anti-cancer therapies in patients with prevalent cancer. In contrast, reverse cardio-oncology describes the phenomenon that cancer is more often discovered in patients with prevalent cardiovascular disease. In the more established field of forward cardio-oncology, the focus has been on the diverse array of anti-cancer drugs used to treat different types of cancer that are associated with wide-ranging cardiotoxic effects, such as atrial fibrillation and venous embolism. The developing field of reverse cardio-oncology was launched by initial observations made in clinical registries where the incidence of cancer was common among patients with heart failure. Clinical observations led to the development of murine models of cancer which found the presence of heart failure accelerated tumor growth and considered possible pro-oncogenic factors such as cytokines and extracellular vesicles, along with the microbiome and the immune system. One multifactorial disease is often clinically associated with another multifactorial disease, and underlying physiological mechanisms are complex and multifactorial as well. To learn more, listen now.

Wouter C. Meijers, Joseph Pierre Aboumsallem, Alexander R. Lyon, Javid Moslehi, and Rudolf A. de Boer Forward and reverse cardio-oncology Physiological Reviews, published September 22, 2025. DOI: 10.1152/physrev.00041.2024