Daniel H Chen1,2,3, Sara Tyebally1,2, Michael Malloupas2,3, Rebecca Roylance2,4, Emma Spurrell2,5, Fharat Raja2,6, Arjun K Ghosh7,8,9. 1. Cardio-Oncology Service, Bart's Heart Centre, St Bartholomew's Hospital, London, EC1A 7BE, UK. 2. University College London Hospital, 235 Euston Road, London, NW1 2BU, UK. 3. The Hatter Cardiovascular Institute, 67 Chenies Mews, London, WC1E 6HX, UK. 4. NIHR University College London Hospitals Biomedical Research Centre, Maple House 1st Floor, 149 Tottenham Court Road, London, W1T 7DN, UK. 5. Whittington Health, Magdala Avenue, London, N19 5NF, UK. 6. North Middlesex University Hospital, Sterling Way, London, N18 1QX, UK. 7. Cardio-Oncology Service, Bart's Heart Centre, St Bartholomew's Hospital, London, EC1A 7BE, UK. arjun.ghosh@nhs.net. 8. University College London Hospital, 235 Euston Road, London, NW1 2BU, UK. arjun.ghosh@nhs.net. 9. The Hatter Cardiovascular Institute, 67 Chenies Mews, London, WC1E 6HX, UK. arjun.ghosh@nhs.net.
Abstract
PURPOSE OF REVIEW: Cardiotoxicity can occur acutely during breast cancer treatment and impact the potential for the intended cancer treatment regime to be completed, or as a late effect affecting cancer survivorship. Indeed, the most common cause of mortality in females with early breast cancer is cardiovascular disease, especially in those over the age of 65. Optimal cancer care therefore needs to be delivered without jeopardising cardiovascular health. Understanding the different cardiotoxicities associated with breast cancer treatment is vital to this approach, and therefore, this article seeks to provide an overview of this. RECENT FINDINGS: Tyrosine kinase inhibitors targeting human epidermal growth factor receptor (HER)-2, immune checkpoint inhibitors (ICI), and cyclin-dependent kinase (CDK) inhibitors are new targeted breast cancer treatments. In particular, ICI are associated with myocarditis that carries a significant mortality, whilst the CDK inhibitor ribociclib causes QT prolongation that requires cardiac surveillance and appropriate dose adjustment to prevent ventricular arrhythmias. The need has always been for strategies to mitigate the risks of cardiovascular toxicities, and new data is promising for the use of dexrazoxane in anthracyclines, and the role of beta blockers and angiotensin converting enzymes inhibitors in anthracyclines and HER-2 monoclonal antibodies such as trastuzumab. Significant headways in breast cancer treatment have resulted in reductions in disease recurrence and mortality, but cardiovascular complications continue to impact the ability to deliver some of these cancer treatments, and the period of cancer survivorship.
PURPOSE OF REVIEW: Cardiotoxicity can occur acutely during breast cancer treatment and impact the potential for the intended cancer treatment regime to be completed, or as a late effect affecting cancer survivorship. Indeed, the most common cause of mortality in females with early breast cancer is cardiovascular disease, especially in those over the age of 65. Optimal cancer care therefore needs to be delivered without jeopardising cardiovascular health. Understanding the different cardiotoxicities associated with breast cancer treatment is vital to this approach, and therefore, this article seeks to provide an overview of this. RECENT FINDINGS: Tyrosine kinase inhibitors targeting humanepidermal growth factor receptor (HER)-2, immune checkpoint inhibitors (ICI), and cyclin-dependent kinase (CDK) inhibitors are new targeted breast cancer treatments. In particular, ICI are associated with myocarditis that carries a significant mortality, whilst the CDK inhibitor ribociclib causes QT prolongation that requires cardiac surveillance and appropriate dose adjustment to prevent ventricular arrhythmias. The need has always been for strategies to mitigate the risks of cardiovascular toxicities, and new data is promising for the use of dexrazoxane in anthracyclines, and the role of beta blockers and angiotensin converting enzymes inhibitors in anthracyclines and HER-2 monoclonal antibodies such as trastuzumab. Significant headways in breast cancer treatment have resulted in reductions in disease recurrence and mortality, but cardiovascular complications continue to impact the ability to deliver some of these cancer treatments, and the period of cancer survivorship.
Entities:
Keywords:
Breast cancer; Cardiotoxicity; Heart failure
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