Effective cardioprotection with early initiation of sacubitrilvalsartan in a patient with breast cancer and cancer treatment-induced heart failure

Sacubitril-valsartan: Hope or hype in the battle against cardiotoxicity due to cancer treatment?

“…More interestingly, sacubitril-valsartan seemed to induce a substantial LV reverse remodeling leading to a significant increase in the LVEF value of the patient with overt cardiomyopathy [1]. This might imply that this agent might be even more efficacious when initiated during the stage of "early cardiotoxicity" and might potentially prevent transition to late cardiomyopathy.…”

“…In cardio-oncological practice, the term "cardiotoxicity" is defined as a new-onset myocardial injury/dysfunction mostly in response to a variety of chemotherapeutic regimens including anthracyclins and trastuzumab, etc. [1][2][3]. In their recently published article, Sławiński et al [1] have reported the favorable impact of sacubitril-valsartan (an angiotensin receptor-neprilysin inhibitor) on the recovery of left ventricular (LV) systolic dysfunction associated with cancer treatment in a patient with breast cancer.…”

“…[1][2][3]. In their recently published article, Sławiński et al [1] have reported the favorable impact of sacubitril-valsartan (an angiotensin receptor-neprilysin inhibitor) on the recovery of left ventricular (LV) systolic dysfunction associated with cancer treatment in a patient with breast cancer. Accordingly, we would like to have further information regarding that interesting case and make a few comments on cardiotoxicity and its management with sacubitril-valsartan in cancer survivors.…”

“…However, when these initial changes go unnoticed following a cardiotoxic regimen, "early cardiotoxicity" generally progresses to "overt cardiotoxicity" that usually emerges as a form of late cardiomyopathy (universally characterized by a 10% reduction in the LVEF value from baseline to an ultimate value of <53% [or 50]) [2][3][4]. Apparently, the patient [1] initially seemed to have a pattern of "early cardiotoxicity" (presenting with slight reductions in LVEF and GLS values) that ultimately ended up with overt cardiotoxicity in the later stages. However, the diagnosis of "cardiotoxicity" traditionally needs also to be substantiated with persistent increases (mostly weeks apart) in troponins and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels [2,3].…”

“…might have the potential to block or slow down the progression of "early cardiotoxicity" [2][3][4]. However, despite the initiation of these agents (all were previously documented to have significant favorable effects in this context [4]), the patient was reported to ultimately progress to late cardiomyopathy [1]. Accordingly, we are interested in the dosages and duration of the use of these cardioprotective agents.…”