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Background in the recent years, survival of cancer patients increased enormously through the use of new anticancer drugs such as molecular target drugs (tyrosine kinase inhibitors- TKIs, immunotherapy). Immunotherapy includes anti-BRAF and anti-MEK drugs (although evidences are scarce, these drugs seem to be capable of causing cardiovascular toxicity too); TKIs includes inhibitors of VEGF, VEGFR and other kinases. Purpose to assess cardiovascular toxic effects of TKIs and immunotherapy, to identify early signs of cardiac and vascular toxicity using speckle tracking echocardiography and arterial stiffness measurement. Methods a prospective study was carried out evaluating 45 patients treated with immunotherapy or TKIs. Population was divided into 2 groups: Group A (17 patients with melanoma treated with anti- BRAF and anti-MEK) and Group B (28 patients with solid cancer treated with TKIs-anti VEGF). Cardiological evaluation including electrocardiogram, conventional echocardiogram with tissue Doppler imaging (TDI) and left ventricular global longitudinal strain (GLS) measurement and carotid ultrasound scan was carried out before starting therapy and at a follow-up time of 6 and 12 months. Cardiovascular events such as heart failure, arterial hypertension, arrhythmias, Qtc interval prolongation, stroke, arterial and venous thrombosis were assessed during follow-up. Results mean follow-up was 7 months for anti-BRAF and 13 months for TKI. Neither cardiovascular adverse events nor significant reductions in LVEF or other echocardiographic parameters during follow-up were observed in Group A: we did not observe significant changes in GLS (-18,4 [RI -19,9 a -15,8] vs. -18,3 [RI -18,9 a -16,1] or in vascular parameters (PWV 7,3 ± 1,4 vs. 6,7 ± 1,5, β mean wave 8,5 [RI 6,3-12] vs. 7,4 [RI 4,9-9,4]; α mean wave 6,8 [RI 3,1-6,2] vs. 9,6 [RI 2,4-4,6]). As regards Group B, new onset of arterial hypertension in 35% of population but no significant changes in LVEF or other echocardiographic parameters including GLS ( -18,6 ± 2,3 vs. -18,3 ± 3,3) were observed. Significant changes were furthermore found in vascular parameters with increased arterial stiffness during follow-up (PWV 7,82 ± 1,23 vs. 10,02 ± 2,73; p = 0,04, β mean wave 5,33 ± 1,98 vs. 8,43 ± 3,03; p = 0,02, α mean wave 10,79 ± 4,03 vs.16,82 ± 6,38; p = 0,03). Conclusions according to the literature data, immunotherapy seems to have a safe cardiovascular profile. Anti-VEGF drugs seem to predominantly cause vascular damage, early identifiable through arterial stiffness measurement.