Abstract:Cardio-oncology is an emerging field tasked with identifying and treating cancer therapy related cardiac dysfunction (e.g., cytotoxic agents, immunotherapies, radiation, and hormone therapies) and optimizing the cardiovascular health of cancer patients exposed to these agents. Novel cancer therapies have led to significant improvements in clinical outcomes for breast cancer patients. In this article, we review the current literature on assessing cardiovascular risk of breast cancer therapies and discuss strate… Show more
“…The small sample size, short follow-up durations, and single-centred design highlight the need for multicentre, adequately powered randomized controlled trials. Longer follow-up duration and clinically meaningful endpoints are also required [ 121 , 152 ]. Fig.…”
Cancer and cardiovascular diseases, including heart failure (HF), are the main causes of death in Western countries. Several anticancer drugs and radiotherapy have adverse effects on the cardiovascular system, promoting left ventricular dysfunction and ultimately HF. Nonetheless, the relationship between cancer and HF is likely not unidirectional. Indeed, cancer and HF share common risk factors, and both have a bidirectional relationship with systemic inflammation, metabolic disturbances, and neurohormonal and immune activation. Few studies have assessed the impact of untreated cancer on the heart. The presence of an active cancer has been associated with elevated cardiac biomarkers, an initial impairment of left ventricular structure and function, autonomic dysfunction, and reduced exercise tolerance. In turn, these conditions might increase the risk of cardiac damage from chemotherapy and radiotherapy. HF drugs such as beta-blockers or inhibitors of the renin–angiotensin–aldosterone system might exert a protective effect on the heart even before the start of cancer therapies. In this review, we recapitulate the evidence of cardiac involvement in cancer patients naïve from chemotherapy and radiotherapy and no history of cardiac disease. We also focus on the perspectives for an early diagnosis and treatment to prevent the progression to cardiac dysfunction and clinical HF, and the potential benefits of cardioactive drugs on cancer progression.
“…The small sample size, short follow-up durations, and single-centred design highlight the need for multicentre, adequately powered randomized controlled trials. Longer follow-up duration and clinically meaningful endpoints are also required [ 121 , 152 ]. Fig.…”
Cancer and cardiovascular diseases, including heart failure (HF), are the main causes of death in Western countries. Several anticancer drugs and radiotherapy have adverse effects on the cardiovascular system, promoting left ventricular dysfunction and ultimately HF. Nonetheless, the relationship between cancer and HF is likely not unidirectional. Indeed, cancer and HF share common risk factors, and both have a bidirectional relationship with systemic inflammation, metabolic disturbances, and neurohormonal and immune activation. Few studies have assessed the impact of untreated cancer on the heart. The presence of an active cancer has been associated with elevated cardiac biomarkers, an initial impairment of left ventricular structure and function, autonomic dysfunction, and reduced exercise tolerance. In turn, these conditions might increase the risk of cardiac damage from chemotherapy and radiotherapy. HF drugs such as beta-blockers or inhibitors of the renin–angiotensin–aldosterone system might exert a protective effect on the heart even before the start of cancer therapies. In this review, we recapitulate the evidence of cardiac involvement in cancer patients naïve from chemotherapy and radiotherapy and no history of cardiac disease. We also focus on the perspectives for an early diagnosis and treatment to prevent the progression to cardiac dysfunction and clinical HF, and the potential benefits of cardioactive drugs on cancer progression.
“…Owing to a lack of specific validated biomarkers for RIHD and also of imaging techniques with sufficient sensitivity and specificity to detect subclinical disease, our options are limited when attempting an early diagnosis in asymptomatic women upon whom specific corrective measures could potentially be used [ 64 ]. In addition, we have no cardioprotective pharmacological treatments proven to be effective at preventing or altering the natural history of RT injury [ 65 , 66 ], and evidence of the impact of acting upon baseline cardiovascular risk factors is lacking. Moreover, the fact that this corresponds to a chronic adverse event with a latency of years and a low prevalence makes it difficult to study the impact of these interventions in clinical trials.…”
In recent decades, improvements in breast cancer management have increased overall patient survival; however, many cancer therapies have been linked to an important risk of cardiovascular adverse events. Cardio-oncology has been proposed as an emerging specialty to coordinate preventive strategies that improve the cardiovascular health of oncologic patients. It employs the most suitable personalized multidisciplinary management approach for each patient to optimize their cardiovascular health and improve their survival and quality of life. Radiotherapy is an essential part of the therapeutic regimen in breast cancer patients but can also increase the risk of cardiovascular disease. Therefore, minimizing the negative impact of radiation therapy is an important challenge for radiotherapy oncologists and cardiologists specializing in this field. The aim of the present review is to update our knowledge about radiation-induced cardiotoxicity in breast cancer patients by undertaking a critical review of the relevant literature to determine risk prevention and control strategies currently available.
“…A recent study from Memorial Sloan Kettering Cancer Center (1396 women) corroborated an increased risk of breast cancer recurrence and death with interruption of trastuzumab therapy, 24% (interrupted) vs. 13% (continuous), highlighting the importance of continued investigation of monitoring, prevention, and management of cardiac dysfunction to limit treatment interruption or cessation [60]. Several prospective studies, namely, PRADA, MANTICORE, Guglin et al, Boekhout et al, suggest ACE inhibitors and/or beta-blockers for primary prevention in HER2-positive breast cancer patients with/without combination anthracycline therapy (Table 3) [61]. While these strategies may facilitate patients completing a recommended course of HER2-targeted therapy, larger prospective studies in "at risk" (e.g., low LVEF of 50% at baseline) populations are needed prior to widespread adoption of this approach in clinical practice.…”
Section: Cardiovascular Monitoring Strategies For Her2-targeted Therapymentioning
Purpose of Review HER2-targeted therapies have led to improved clinical outcomes in early and advanced breast cancer (BC). We review the long-term cardiotoxicity of HER2-targeted therapy in early and advanced BC, our current knowledge of cardiotoxicity of novel HER2-targeted therapies, and propose a cardiac monitoring (CM) strategy for this population. Recent Findings Long-term data from studies with HER2-targeted therapy in the adjuvant setting have failed to demonstrate an increase in cardiotoxicity over time, and rates of cardiotoxicity seen with novel HER2 agents remain low. Despite over a decade of experience with HER2-targeted therapy, CM in clinical practice is inconsistent in patients with early BC and almost non-existent in advanced BC. Summary Long-term follow-up of clinical trials with HER2-targeted agents in early and advanced BC has failed to demonstrate increased rates of cardiotoxicity over time, attesting to the long-term safety of this class of drugs for the majority of patients, although the long-term cardiac safety of newer HER2 agents in the non-clinical trial setting is largely unknown. We propose CM incorporating clinical history, cardiac imaging, and biomarkers.
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