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Review
. 2025 Jul 30;17(15):2506.
doi: 10.3390/cancers17152506.

Long-Term Adverse Events Following Early Breast Cancer Treatment with a Focus on the BRCA-Mutated Population

Berta Obispo  1 , Caroline Bailleux  2 , Blanca Cantos  3 , Pilar Zamora  4 , Sachin R Jhawar  5   6 , Jajini Varghese  7 , Lucia Cabal-Hierro  8 , Paulo Luz  8 , Luis Berrocal-Almanza  9 , Xiaoqing Xu  10
Affiliations
Review

Long-Term Adverse Events Following Early Breast Cancer Treatment with a Focus on the BRCA-Mutated Population

Berta Obispo et al. Cancers (Basel). .

Abstract

Breast cancer (BC) is the most prevalent malignancy in women worldwide. Despite most cases being diagnosed in the early stages, patients typically require a multimodal treatment approach. This typically involves a combination of surgery, radiotherapy, systemic treatments (including chemotherapy or immunotherapy), targeted therapy, and endocrine therapy, depending on the disease subtype and the risk of recurrence. Moreover, patients with BC and germline mutations in the breast cancer genes 1 or 2 (BRCA1/BRCA2), (gBRCAm), who are typically young women, often require more aggressive therapeutic interventions. These mutations present unique characteristics that necessitate a distinct treatment approach, potentially influencing the side effect profiles of patients with BC. Regardless of the clear benefit observed with these treatments in terms of reduced recurrence and mortality rates, long-term, treatment-related adverse events occur that negatively affect the health-related quality of life (HRQoL) of BC survivors. Thus, long-term adverse events need to be factored into the treatment decision algorithm of patients with early BC (eBC). Physical, functional, emotional, and psychosocial adverse events can occur and represent a significant concern and a challenge for clinicians, patients, and their families. This review article provides an overview of the various long-term adverse events that patients with eBC may experience, including their associated risk factors, as well as management and prevention strategies. We also explore the evidence of the long-term impact of treatment on the HRQoL of patients with gBRCAm. By providing a comprehensive overview of current evidence and recommendations regarding patients' HRQoL, we aim to equip clinicians with scientific and clinical knowledge and provide guidance to optimize care and improve long-term outcomes.

Keywords: (neo)adjuvant treatment; BRCA mutation; breast cancer survivorship; cancer treatment optimization; early breast cancer; health-related quality of life; long-term adverse events; long-term toxicity.

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Conflict of interest statement

B.O. acts as a speaker for AstraZeneca. C.B. receives consulting fees from Novartis, AstraZeneca, Daiichi-Sankyo, and Lilly, acts as a speaker for Viatris, Novartis, and Lilly, and receives support from attending meetings and/or travel from MS, AstraZeneca, Daiichi-Sankyo, and Novartis. B.C. is a grant and/or contract receiver from Roche and Pfizer, acts as a consultant for Daiichi-Sankyo, AstraZeneca, MSD, Lilly, Novartis, Pfizer, and Gilead, and receives support for attending meetings and/or travel from Novartis, Pfizer, and Daiichi-Sankyo. P.Z. receives support from attending meetings and/or travel from Pfizer, Novartis, and Daiichi-Sankyo. S.R.J. is a member of the advisory board of Enlace Health and a grant holder from different public and private entities. J.V. has no conflicts of interest. L.C.-H is a full-time employee at Savana Research, Madrid, Spain. P.L. was also a full-time employee at Savana Research during manuscript development. L.B.-A. and X.X. are full-time employees at AstraZeneca.

Figures

Figure 1
Figure 1
Literature search and review approach.
Figure 2
Figure 2
Schematic representation of the possible early and later-onset adverse events related to treatment in patients with eBC and gBRCA mutation. AE: adverse event, eBC: early breast cancer, gBRCA: germline BRCA, GI: gastrointestinal. Red dot represents tumor location.
See this image and copyright information in PMC

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