{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:43:24Z","timestamp":1760060604117,"version":"build-2065373602"},"reference-count":18,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,9,13]],"date-time":"2025-09-13T00:00:00Z","timestamp":1757721600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Cancer patients have not been included in landmark trials of SGLT2is in heart failure, so data on safety and effectiveness are lacking. TOSCA is a multi-center observational trial including patients with active cancer receiving SGLT2is for HF treatment. The primary endpoint was safety, and the secondary endpoint was effectiveness. Exploratory endpoints included drug\u2013drug interactions, treatment of cancer therapy-related cardiac dysfunction (CTRCD), and changes in NT-proBNP. One-hundred and twenty-nine patients (median age 72 [range 44\u201392] yrs) were enrolled who had been receiving SGLT2i for a median of 3 (range 3\u201325) months. Prevalent etiology was drug-induced HF with HFrEF as the most frequent clinical presentation. The incidence of urinary tract infections was 1.8%, with no cases of genital infections, hypoglycemia, diabetic ketoacidosis, acute renal injury, thrombosis, or bone fractures. The mean overall EF increased (40.3% vs. 47.4%), and NYHA class improved in 19% of cases. Rates of unplanned cardiology visits (0.9%), use of i.v. diuretics (0.9%), coronary angiography (4.5%), emergency access for HF (1.8%), and new HF episodes (3.6%) were extremely low. In 11 cases (8.5%), the initiation of SGLT2i enabled continuation of anticancer therapy that would have otherwise been delayed or suspended due to HF decompensation. SGLT2is appeared effective in 34 cases of CTRCD. No drug\u2013drug interactions were reported. SGLT2is confirmed their safety and effectiveness in active cancer patients with HF, with a potential cardioprotective effect. No new safety warnings were recorded.<\/jats:p>","DOI":"10.3390\/jcdd12090354","type":"journal-article","created":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T10:51:33Z","timestamp":1757933493000},"page":"354","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Safety and Effectiveness of Sodium-Glucose Co-Transporter 2 Inhibitors in Active Cancer Patients with Heart Failure: Results of the Observational TOSCA Trial"],"prefix":"10.3390","volume":"12","author":[{"given":"Maria Laura","family":"Canale","sequence":"first","affiliation":[{"name":"Department of Cardiology, Versilia Hospital\u2014Azienda USL Toscana Nord Ovest, 55041 Lido Di Camaiore, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iacopo","family":"Fabiani","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0850-2761","authenticated-orcid":false,"given":"Maria Grazia","family":"Delle Donne","sequence":"additional","affiliation":[{"name":"Department of Cardiology, UO Cardiologia 1, Azienda Ospedaliero Universitaria Pisana, 56122 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8446-8927","authenticated-orcid":false,"given":"Michela","family":"Chianca","sequence":"additional","affiliation":[{"name":"Scuola di Specializzazione Cardiologia, University of Pisa, 56122 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4231-7781","authenticated-orcid":false,"given":"Valentina","family":"Barletta","sequence":"additional","affiliation":[{"name":"Department of Cardiology, UO CARDIOLOGIA 2, Azienda Ospedaliero Universitaria Pisana, 56122 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eugenia","family":"Capati","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Livorno Hospital, Azienda USL Toscana Nord Ovest, 57100 Livorno, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monica","family":"Solinas","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Versilia Hospital\u2014Azienda USL Toscana Nord Ovest, 55041 Lido Di Camaiore, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lara","family":"Frediani","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Villamarina Hospital, Azienda USL Toscana Nord Ovest, 57025 Piombino, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7223-7574","authenticated-orcid":false,"given":"Elio","family":"Venturini","sequence":"additional","affiliation":[{"name":"Unit of Cardiac Rehabilitation, Azienda USL Toscana Nord Ovest, Cecina Hospital, 57023 Cecina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0266-6493","authenticated-orcid":false,"given":"Giuseppe","family":"Arena","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Nuovo Ospedale Apuano, Azienda USL Toscana Nord Ovest, 54100 Massa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulio","family":"Zucchelli","sequence":"additional","affiliation":[{"name":"Department of Cardiology, UO CARDIOLOGIA 2, Azienda Ospedaliero Universitaria Pisana, 56122 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emilio Maria","family":"Pasanisi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Livorno Hospital, Azienda USL Toscana Nord Ovest, 57100 Livorno, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Domenico","family":"Amoroso","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Versilia Hospital, Azienda USL Toscana Nord Ovest, 55041 Lido Di Camaiore, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giacomo","family":"Allegrini","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Livorno Hospital, Azienda USL Toscana Nord Ovest, 57100 Livorno, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1637-574X","authenticated-orcid":false,"given":"Raffaele","family":"De Caterina","sequence":"additional","affiliation":[{"name":"Department of Cardiology, UO Cardiologia 1, Azienda Ospedaliero Universitaria Pisana, 56122 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michele","family":"Emdin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, 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