Permissive Cardiotoxicity in Cancer Care: Bending but Not Breaking

This case-driven session explores when controlled, physiology-guided cardiotoxicity may be acceptable during contemporary cancer therapy in patients with HF Stages B–D. Through a stage-based lens, faculty will review myocardial injury, adaptive reserve, reversibility thresholds, and surveillance strategies, offering clear guidance on when to intensify cardioprotection, permit exposure, or modify goals of care. Participants will leave with a practical, nuanced framework for balancing cancer treatment efficacy with cardiac safety.

Learning Objectives

• Assess cardiac reserve and reversibility using imaging, biomarkers, and hemodynamic data to define thresholds for acceptable risk.
• Implement longitudinal surveillance and cardioprotective strategies that allow continuation of oncologic therapy while minimizing progression to irreversible heart failure.
• Navigate complex clinical and ethical trade-offs in advanced heart failure, including treatment limitation, escalation, and alignment of cardiac and oncologic goals of care.