Permissive Cardiotoxicity: An Evolving Paradigm.

Permissive cardiotoxicity is an evolving clinical practice pattern that balances the management of cancer treatment-associated cardiotoxicities with the risk of interrupting lifesaving or life-extending cancer treatments. This paradigm shift has been catalyzed by advancements in the diagnostic and therapeutic tools available to treating clinicians, as well as a recognition of the consequences of withholding or delaying cancer therapy. Permissive cardiotoxicity has become a central tenet in the practice of cardio-oncologists; however, recognition and confidence in managing cardiotoxicity is also crucial for the general cardiologist and oncologist due to the growing population of patients with cancer. This review aims to (1) highlight the philosophy of permissive cardiotoxicity, (2) provide a framework for risk stratification of cardiovascular toxicities, (3) describe systems of care considerations for successful implementation of permissive cardiotoxicity, and (4) review the existing literature and guideline recommendations for specific cardiovascular toxicity mitigation.