https://doi.org/10.4081/monaldi.2023.2514
Cardiovascular toxicity in breast cancer patients – contributors and role of cardioprotective drugs
Submitted: December 30, 2022
Accepted: January 30, 2023
Published: March 28, 2023
Accepted: January 30, 2023
Abstract Views: 1252
PDF: 301
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Breast cancer (BC) patients treated with anthracyclines and/or anti-HER2-targeted therapies (AHT) are highly associated with cardiovascular toxicity (CVT). Our objective was to evaluate the risk of CVT secondary to cancer treatment and the role of cardioprotective-drugs (CPD) in BC patients. We collected a retrospective cohort of females with BC treated with chemotherapy and/or AHT from 2017 to 2019. CVT was defined as LVEF<50% or decline ≥10% during follow-up. As CPD, we considered renin-angiotensin-aldosterone-system inhibitors and beta-blockers. A subgroup analysis of the AHT patients was also performed. A total of 203 women were enrolled. The majority had high or very-high CVT risk score and normal cardiac function at presentation. As for CPD, 35.5% were medicated pre-chemotherapy. All patients were submitted to chemotherapy; AHT were applied to 41.7%. During a 16 months follow-up, 8.5% developed CVT. There was a significant decrease of GLS and LVEF at 12-months (decrease of 1.1% and 2.2%, p<0.001). AHT and combined therapy were significantly associated with CVT. In the AHT sub-group analysis (n=85), 15.7% developed CVT. Patients previously medicated with CPD had a significative lower incidence of CVT (2.9% vs 25.0%, p=0.006). Patients already on CPD presented a higher LVEF at 6-months follow-up (62.5% vs 59.2%, p=0.017). Patients submitted to AHT and anthracycline therapy had higher risk of developing CVT. In the AHT sub-group, pre-treatment with CPD was significantly associated with a lower prevalence of CVT. These results highlight the importance of cardio-oncology evaluation and strengthen the value of primary prevention.
World Health Organization International Agency for Research on Cancer (IARC). GLOBOCAN 2020: estimated cancer incidence, mortality and prevalence worldwide in 2020. 2020. Accessed 2022 Jul 23. Available from: https://gco.iarc.fr/today/fact-sheets-cancers
Naaktgeboren WR, Linschoten M, de Graeff A, et al. Long-term cardiovascular health in adult cancer survivors. Maturitas 2017;105:37-45.
DOI: https://doi.org/10.1016/j.maturitas.2017.05.014
Pondé NF, Lambertini M, de Azambuja E. Twenty years of anti-HER2 therapy-associated cardiotoxicity. ESMO Open 2016;1:e000073.
DOI: https://doi.org/10.1136/esmoopen-2016-000073
Slamon D, Eiermann W, Robert N, et al. Adjuvant trastuzumab in HER2-positive breast cancer. N Engl J Med 2011;365:1273-83.
DOI: https://doi.org/10.1056/NEJMoa0910383
Yu AF, Yadav NU, Lung BY, et al. Trastuzumab interruption and treatment-induced cardiotoxicity in early HER2-positive breast cancer. Breast Cancer Res Treat 2015;149:489-95.
DOI: https://doi.org/10.1007/s10549-014-3253-7
Piccart-Gebhart MJ, Procter M, Leyland-Jones B, et al. Trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer. N Engl J Med 2005;353:1659-72.
DOI: https://doi.org/10.1056/NEJMoa052306
Yamaguchi N, Fujii T, Aoi S, et al. Comparison of cardiac events associated with liposomal doxorubicin, epirubicin and doxorubicin in breast cancer: a Bayesian network meta-analysis. Eur J Cancer 2015;51:2314-20.
DOI: https://doi.org/10.1016/j.ejca.2015.07.031
Zamorano JL, Lancellotti P, Rodriguez Muñoz D, et al. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: The Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC). Eur Heart J 2016;37:2768-801.
DOI: https://doi.org/10.1093/eurheartj/ehw211
Lyon AR, López-Fernández T, Couch LS, et al. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J 2022;43:4229-61.
DOI: https://doi.org/10.1093/eurheartj/ehac244
Cardinale D, Colombo A, Bacchiani G, et al. Early detection of anthracycline cardiotoxicity and improvement with heart failure therapy. Circulation 2015;131:1981-8.
DOI: https://doi.org/10.1161/CIRCULATIONAHA.114.013777
Barros-Gomes S, Herrmann J, Mulvagh SL, et al. Rationale for setting up a cardio-oncology unit: our experience at Mayo Clinic. Cardiooncology 2016;2:5.
DOI: https://doi.org/10.1186/s40959-016-0014-2
Čelutkienė J, Pudil R, López-Fernández T, et al. Role of cardiovascular imaging in cancer patients receiving cardiotoxic therapies: a position statement on behalf of the Heart Failure Association (HFA), the European Association of Cardiovascular Imaging (EACVI) and the Cardio-Oncology Council of the European Society of Cardiology (ESC). Eur J Heart Fail 2020;22:1504-24.
DOI: https://doi.org/10.1002/ejhf.1957
Plana JC, Galderisi M, Barac A, et al. Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imag 2014;15:1063-93.
DOI: https://doi.org/10.1093/ehjci/jeu192
Martins de Carvalho M SC. Cardio-oncology: the future is now! Rev Port Cardiol 2022;41:985-6.
DOI: https://doi.org/10.1016/j.repc.2022.08.005
Čelutkienė J, Plymen CM, Flachskampf FA, et al. Innovative imaging methods in heart failure: a shifting paradigm in cardiac assessment. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2018;20:1615-33.
DOI: https://doi.org/10.1002/ejhf.1330
Caspani F, Tralongo AC, Campiotti L, et al. Prevention of anthracycline-induced cardiotoxicity: a systematic review and meta-analysis. Intern Emerg Med 2021;16:477-86.
DOI: https://doi.org/10.1007/s11739-020-02508-8
Vaduganathan M, Hirji SA, Qamar A, et al. Efficacy of neurohormonal therapies in preventing cardiotoxicity in patients with cancer undergoing chemotherapy. JACC CardioOncol 2019;1:54-65.
DOI: https://doi.org/10.1016/j.jaccao.2019.08.006
Fang K, Zhang Y, Liu W, et al. Effects of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use on cancer therapy-related cardiac dysfunction: a meta-analysis of randomized controlled trials. Heart Fail Rev 2021;26:101-9.
DOI: https://doi.org/10.1007/s10741-019-09906-x
Pinho JF, Nunes JP, Paiva M, et al. Is dyslipidemia a risk factor for trastuzumab-induced cardiotoxicity in breast cancer patients? - A Systematic review and meta-analysis. Port Cardiol 2023. Online Ahead of Print.
DOI: https://doi.org/10.1016/j.repc.2022.10.016
How to Cite
Martins Carvalho, Miguel, Ricardo Alves Pinto, Tânia Proença, Inês Costa, Nuno Tavares, Mariana Paiva, Carla Sousa, and Filipe Macedo. 2023. “Cardiovascular Toxicity in Breast Cancer Patients – Contributors and Role of Cardioprotective Drugs”. Monaldi Archives for Chest Disease 93 (4). https://doi.org/10.4081/monaldi.2023.2514.
Copyright (c) 2023 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- Elio Gorga, Marta Scodro, Francesca Valentini, Renzo D'Ortona, Mariachiara Arisi, Edoardo Sciatti, Ivano Bonadei, Valentina Regazzoni, Enrico Vizzardi, Marco Metra, Piergiacomo Calzavara Pinton, Echocardiographic evaluation of diastolic dysfunction in young and healthy patients with psoriasis: A case-control study , Monaldi Archives for Chest Disease: Vol. 88 No. 3 (2018)
- Marinella Sommaruga, Elisabetta Angelino, Paola Della Porta, Mara Abatello, Giacomo Baiardo, Gianluigi Balestroni, Ornella Bettinardi, Edward Callus, Chiara Ciracì, Ombretta Omodeo, Claudia Rizza, Paolo Michielin, Marco Ambrosetti, Raffaele Griffo, Roberto F.E. Pedretti, Antonia Pierobon, Best practice in psychological activities in cardiovascular prevention and rehabilitation: Position Paper , Monaldi Archives for Chest Disease: Vol. 88 No. 2 (2018)
- Gabriele Valli, Francesca De Marco, Maria Teresa Spina, Valentina Valeriano, Antonello Rosa, Valentina Minerva, Enrico Mirante, Maria Pia Ruggieri, Francesco Rocco Pugliese, A pilot study on the application of the current European guidelines for the management of acute coronary syndrome without elevation of ST segment (NSTEMI) in the Emergency Department setting in the Italian region Lazio , Monaldi Archives for Chest Disease: Vol. 82 No. 4 (2014): Cardiac series
- Francesco Barillà , Concetta Torromeo, Riccardo Iorio, Luigina Porco, Vincenzo Paravati, Carlo Gaudio, Antiplatelet therapy in elderly patients with acute coronary syndrome: Between scientific evidence and future perspectives , Monaldi Archives for Chest Disease: Vol. 88 No. 2 (2018)
- Claudio F. Donner, Sandro Amaducci, Elena Bacci, Sandra Baldacci, Maria L. Bartoli, Gianfranco M. Beghi, Alida Benfante, Sara Brighindi, Lucio Casali, Daniela Castiglia, Mario Cazzola, Alessandro Celi, Silvana Cianchetti, Giorgio Colombo, Claudia Crimi, Federico L. Dente, Giuseppe Di Maria, Annalisa Di Maria, Manuela Latorre, Federico Lavorini, Sara Maio, Claudia Mannini, Riccardo Messina, Pier Luigi Paggiaro, Patrizia Pignatti, David Price, Nicola Scichilone, Marzia Simoni, Antonio Spanevello, Martina Stagno d’Alcontres, Shawna Tan, Roberto Torchio, Giovanni Viegi, Dina Visca, Emiel F.M. Wouters, Shaylynn Yu Hui Xin, Inhalation therapy in the next decade: Determinants of adherence to treatment in asthma and COPD , Monaldi Archives for Chest Disease: Vol. 88 No. 1 (2018)
- Marco Ambrosetti, Simona Sarzi Braga, Franco Giada, Roberto F.E. Pedretti, Exercise-based cardiac rehabilitation in cardiac resynchronization therapy recipients: A primer for practicing clinicians , Monaldi Archives for Chest Disease: Vol. 87 No. 3 (2017)
- Lucrezia Piccioli, Michele Arcopinto, Andrea Salzano, Roberta D'Assante, Alessandra Schiavo, Francesca M. Stagnaro, Anna Lombardi, Veronica Panicara, Pietro Valente, Giuseppe Vitale, Filippo M. Sarullo, Francesco Giallauria, Alberto M. Marra, The impairment of the Growth Hormone/Insulin-like growth factor 1 (IGF-1) axis in heart failure: A possible target for future therapy , Monaldi Archives for Chest Disease: Vol. 88 No. 3 (2018)
- Francesco Perone, Pilar Zamora Auñon, Laura Rodríguez, David Vinal, Juan Caro-Codon, Ana Pertejo, Virginia Martínez Marín, Enrique Espinosa, Teresa López-Fernández, Cardiac monitoring during trastuzumab therapy in metastatic breast cancer: early incidence of cardiac dysfunction , Monaldi Archives for Chest Disease: Vol. 92 No. 4 (2022)
- Amanda R. Jimenez, Arielle Shaeffer Weiss, Anthony C. Campagna, Use of pulmonary function test demographic data to identify high-risk patients for lung cancer screening , Monaldi Archives for Chest Disease: Vol. 88 No. 1 (2018)
- T. Kontakiotis, N. Manolakoglou, F. Zoglopitis, D. Iakovidis, L. Sacas, A. Papagiannis, A. Mandrali, D. Papakosta, P. Argyropoulou, D. Bouros, Epidemiologic trends in lung cancer over two decades in Northern Greece: an analysis of bronchoscopic data , Monaldi Archives for Chest Disease: Vol. 71 No. 4 (2009): Pulmonary series
You may also start an advanced similarity search for this article.
