Anthracycline cardiotoxicity after breast cancer treatment

Abstract

Anthracyclines are among the most active agents for the treatment of breast cancer; their use in combination regimens improves both disease-free and overall survival in patients with breast cancer. Unfortunately, the clinical utility of anthracycline use is limited by a cumulative dose-dependent cardiac toxicity resulting in congestive heart failure. As methods for detecting and treating breast cancer improve, there has been a steady decline in breast cancer mortality over the past 15 years. With an increasing number of long-term breast cancer survivors, the number of patients experiencing anthracycline-induced cardiotoxicity may also continue to grow. Moreover, new agents used in the treatment of breast cancer can potentiate cardiac toxicity. Recently, studies of non-anthracycline-containing regimens have been found to be effective in preventing recurrence of breast cancer (as compared with anthracycline-containing regimens) in patients with early-stage breast cancer, with a reduced incidence of adverse cardiac outcomes. In this article, we summarize the incidence, presentation, and mechanism of anthracycline-associated cardiotoxicity. We also discuss risk factors for the development of anthracycline-induced cardiotoxicity and new therapies, such as trastuzumab, that may potentiate cardiac toxicity. Finally, we review monitoring and preventive practices that may reduce the long-term risk of anthracycline-related cardiotoxicity.