Cardiotoxicity in Breast Cancer: Impact of Clinical Classifications and Treatment on Heart Health

Abstract

Background/objectives: Cardio-oncology has become essential in addressing cardiovascular complications from cancer therapies. While advancements in treatments have improved survival rates, they also increase cardiovascular risks. This study evaluates the cardiotoxic effects of cytostatic treatments, examining the relationship between tumor characteristics, such as histopathology and TNM classification, and cardiovascular complications, aiming to improve cardiotoxicity prevention and management in oncology patients.

Methods: We conducted a retrospective analysis of cancer patients treated with anthracyclines, HER2-targeted therapies, and radiotherapy. Cardiac function was monitored via echocardiography, focusing on global longitudinal strain and left ventricular ejection fraction (LVEF). Cardiac troponins and natriuretic peptides were measured to detect subclinical cardiotoxicity, with patients stratified by TNM cancer stage and histopathology.

Results: Our analysis identified a significant association between certain cytostatic treatments, such as anthracyclines and HER2-targeted therapies, and a reduction in LVEF, particularly in patients with advanced-stage cancer. Biomarker assessments indicated early signs of cardiotoxicity in patients before clinical symptoms emerged. The findings also demonstrated a higher prevalence of cardiovascular complications in patients with pre-existing risk factors.

Conclusions: This study highlights the importance of personalized treatment protocols in minimizing cardiotoxicity and improving the quality of life for oncology patients. Regular cardiac monitoring, combined with the use of biomarkers, can help identify high-risk patients early, allowing for timely interventions. Future research should focus on optimizing cardioprotective strategies to mitigate the cardiovascular risks associated with modern cancer therapies.

Clinical trial registration: N/A (retrospective study).

Keywords: HER2-targeted therapies; cancer therapies; cardiotoxicity; chemotherapy-induced heart failure; left ventricular ejection fraction (LVEF).

Figure 1

Trend in number of deaths and new cases from 2009 to 2023.

Figure 2

Demographic description of the study cohort regarding age (A), weight in kg (B), height in cm (C), and body surface in kg/m² (D).

Figure 3

Distribution of breast cancer cases by side and classification, where CSE = Clinical Staging Examination, CSI = Cancer Staging Investigation, and CIE = Clinical Imaging Evaluation.

Figure 4

Comparison of health metrics by LVEF categories as age (A), weight (B), height (C), and body surface (D).

Figure 5

Boxplot presentation of the variation in quality of life in patients according to LVEF per cohort (A) and according to cancer stages (B), ○ = isolated cases.