Cardiac Toxicity from Breast Cancer Treatment: Can We Avoid This?

Abstract

Purpose of review: Breast cancer therapies, such as anthracyclines, trastuzumab, and chest irradiation, have well-established cardiotoxicities that lead to adverse outcomes. Here, we will review strategies to mitigate these cardiotoxicities.

Recent findings: Recent consensus guidelines have established criteria for the identification and surveillance of breast cancer patients at increased risk of cardiotoxicity. Dose reduction, liposomal doxorubicin, and dexrazoxane may be considered in high-risk patients receiving anthracyclines. Anthracycline-free regimens should be considered in high-risk patients with HER-2+ breast cancer, if appropriate. Data to support the routine use of concomitant neurohormonal blockade or statins to prevent anthracycline- and trastuzumab-induced cardiomyopathy is not yet available. Strategies that minimize radiation dose to the heart such as deep inspiration and intensity-modulated radiation are recommended to prevent radiation-induced cardiotoxicity. Identification of high-risk patients, aggressive management of underlying cardiovascular risk factors, consideration of cardioprotective strategies, and routine surveillance of left ventricular function before and after therapy are recommended to reduce breast cancer treatment-associated cardiotoxicities.

Keywords: Anthracyclines; Biomarkers; Breast cancer; Cardiotoxicity; Cardiovascular risk factors; Dexrazoxane; Dose; Echocardiography; Exercise; Neurohormonal antagonists; Pegylated liposomal doxorubicin; Prevention; Radiation; Statins; Surveillance; Trastuzumab.