Neoadjuvant Chemotherapy: Friend or Foe

Abstract

Introduction: Most breast cancers require neoadjuvant chemotherapy and the response to primary systemic therapy (PST) is crucial for deciding on the surgical technique and predicting patient outcomes. However, chemotherapy also brings numerous side effects, with cardiovascular issues being some of the most significant, common and challenging to manage.

Case presentation: We present the case of a 71-year-old woman diagnosed with stage T2N1M0 Luminal B breast cancer. It was decided to initiate chemotherapy consisting of four cycles of FEC (5-fluorouracil 600 mg/m² on days 1 and 8, epirubicin 60 mg-90 mg/m² and cyclophosphamide 600 mg/m²), followed by four cycles of docetaxel (75 mg/m² every three weeks). Near the end of the treatment cycles, she developed new-onset angina with complex critical coronary lesions. This required assembling a multidisciplinary team to determine the optimal management strategy from cardiological, surgical, and oncological standpoints. Just when we thought we had found the optimal approach for managing ischemic heart disease, the situation became more complicated with the development of deep vein thrombosis, requiring a reassessment of the entire treatment plan.

Conclusions: Neoadjuvant chemotherapy is an important weapon against breast cancer but also a veritable enemy of cardiovascular diseases. The association of two major diseases requires a multidisciplinary team capable of making the best decisions to maximize benefits and minimize adverse effects.

FIGURE 1.

Chest computed tomography with contrast, arterial phase: pseudonodular tissue lesion in the infero-external quadrant of the left breast

FIGURE 2.

Chest computed tomography with contrast, arterial phase: left axillary lymphadenopathy

FIGURE 3.

Coronary angiography: diffuse stenosis-80-90% in the mid-proximal segment of the left anterior descending artery (LAD) at the site of emergence of the first diagonal branch

FIGURE 4.

Coronary angiography: percutaneous coronary angioplasty (PCI) with pharmacologically active stent implantationat themid-proximal segment of the left anterior descending artery (LAD)

FIGURE 5.

Coronary angiography: balloon dilation at the ostium of the first diagonal-resi­dual stenosis of approximately 30%

FIGURE 6.

Coronary angiography: final angiographic results with TIMI flow

FIGURE 7.

Vascular ultrasound: thrombus partially occupying the left common femoral vein