Defining Cardiovascular Endpoints in Oncology Trials: Challenges and Opportunities

Updated: June 15, 2026

Figure Legend: Framework for Cardiovascular (CV) Safety Evaluation in Oncology Trials: This figure presents a structured framework for assessing cardiovascular (CV) safety in oncology clinical trials across both early and late phases. In early-phase trials, CV safety assessment should be integrated into oncologic dose-finding and efficacy evaluations using routine clinical data, complemented by targeted cardiovascular monitoring based on evolving mechanisms of action (MOA) and preclinical data, to identify trends and compare them with population-level benchmarks in a reiterative process. Late-phase trials require a stepwise approach to CV toxicity characterization, beginning with identification of the underlying mechanism, such as atherosclerosis, thrombosis, myocardial dysfunction, or conduction abnormalities, which guides the selection of clinically meaningful CV endpoints. These endpoints are then assessed and measured using appropriate imaging and biomarker tools. Abbreviations: CV – cardiovascular; ECG – electrocardiogram; CMR – cardiac magnetic resonance; CT – computed tomography; LVEF – left ventricular ejection fraction; GLS – global longitudinal strain; BNP – B-type natriuretic peptide.
  • Cancer therapies can carry meaningful cardiovascular (CV) risks. Oncology trials play an important role in identifying, defining, and interpreting CV effects alongside anticancer benefit.
  • This statement outlines a standardized framework for CV endpoints, including clear definitions, adjudication, baseline testing, surveillance, and the use of biomarkers and patient-reported outcomes.
  • Its broader aim is to make oncology trials more consistent, clinically relevant, and regulator-ready, while strengthening collaboration between oncology and cardiology to better assess net clinical benefit.

Message from the Chairs

In this video, Writing Group Chair Ana Barac, MD, PhD, FAHA and Vice Chair Avirup Guha, MD, FAHA discuss the multidisciplinary effort behind the new statement, including contributions from cardio-oncology experts, clinical trialists, statisticians, and the U.S. Food and Drug Administration, and emphasize alignment with regulatory and oncology communities and support from the American Society of Clinical Oncology (ASCO). The statement provides a framework to enhance trial design, support regulatory decision-making, and ultimately improve care for patients receiving novel cancer therapies.