Evaluation and management of chemotherapy-induced cardiotoxicity in breast cancer: a Delphi study

Abstract

PurposeWhile much progress has been made in the treatment of breast cancer, cardiac complications resulting from therapy remain a significant concern. Both anthracyclines and novel targeted agents can inflict cardiac damage. The present study aimed to evaluate the difference between what it is currently done and what standards of care should be used to minimizing and managing cardiac toxicity in breast cancer survivors.MethodsA two-round multicenter Delphi study was carried out. The panel consisted of 100 oncologists who were asked to define the elected therapies for breast cancer patients, the clinical definition and patterns of cancer drug-derived cardiac toxicity, and those protocols focused on early detection and monitoring of cardiovascular outcomes.ResultsExperts agreed a more recent definition of cardiotoxicity. Around 38 % of patients with early-stage disease, and 51.3 % cases with advanced metastatic breast cancer had preexisting risk factors for cardiotoxicity. Among risk factors, cumulative dose of anthracycline ≥450 mg/m2 and its combination with other anticancer drugs, and a preexisting cardiovascular disease were considered the best predictors of cardiotoxicity. Echocardiography and radionuclide ventriculography have been the proposed methods for monitoring changes in cardiac structure and function. Breast cancer is generally treated with anthracyclines (80 %), so that the panel strongly stated about the need to plan a strategy to managing cardiotoxicity. A decline of left ventricular ejection fraction (LVEF) >10 %, to an LVEF value <53 % was suggested as a criterion for changing the dose schedule of anthracyclines, or suspending the treatment of chemotherapy plus trastuzumab until the normalization of the left ventricular function. The use of liposomal anthracyclines was strongly suggested as a treatment option for breast cancer patients.ConclusionsThe present report is the first to produce a set of statements on the prevention, evaluation and monitoring of chemotherapy-induced cardiac toxicity in breast cancer patients.

Risk factors of trastuzumab-induced cardiotoxicity in breast cancer

“…The intention of this study was not to prescribe or deter providers from using trastuzumab but to highlight the importance of closely monitoring a patient's cardiac function when on trastuzumab and assess when the potential risks of this treatment outweigh the benefits. The recent study posed by Gavila et al [ 42 ] outlines a plan in which both cardiologists and oncologists work together in managing the potential of cardiotoxicity, an approach we believe should become common practice for taking care of cancer patients who undergo treatment with potential for cardiotoxicity [ 43 ] and will ultimately maximize both quality of life and survival.…”

Relationship between Nutritional Status and Clinical and Biochemical Parameters in Hospitalized Patients with Heart Failure with Reduced Ejection Fraction, with 1-year Follow-Up

“…The most prevalent etiology of HF varies worldwide, depending on the region. Its classification remains unclear, because there is a long list of factors that can cause HF, such as ischemic heart disease, cardiomyopathies, hypertension [2], or cytostatic drugs administered in oncology [3].What is more, many patients will simultaneously develop several comorbid conditions and risk factors leading to HF. It is clear that elevated blood pressure, obesity, diabetes mellitus [4], and dyslipidemia [5] contribute to the development of HF.…”

A Novel Small Peptide Inhibitor of NFκB, RH10, Blocks Oxidative Stress‐Dependent Phenotypes in Cancer

“…Chemotherapy and radiations are the common strategies that are engaged to reduce tumor mass in humans. The chemotherapy comprises drugs that at specific dosages are effective to reduce tumor mass but often trigger cardio-toxic effects [ 48 ]. For this reason, new effective and nontoxic drugs are needed to be used as adjuvants in the common therapeutic regimens to sensitize cancer cells and lower the dosages of common toxic drugs.…”