Cardiac Toxicity in Breast Cancer Survivors: Review of Potential Cardiac Problems

Abstract

As breast cancer survival is increased by the diagnosis of earlier-stage disease and treatments improve, the side effects of cancer treatments, such as cardiotoxicity, remain clinically important. Although physicians have known for 30 years that anthracyclines cause acute and chronic cardiotoxicity, the cardiotoxic effects of radiation therapy, hormonal therapy (including tamoxifen and the aromatase inhibitors), and chemotherapy with taxanes and trastuzumab treatment have emerged more recently. This review examines the cardiac toxicity of adjuvant therapy, monitoring for early changes and existing guidelines for monitoring cardiac function in patients with breast cancer.

Reversible cardiotoxicity in a 54-year-old woman treated with trastuzumab

“…New diagnosis resources and more effective therapy schedules have contributed to increase the survival of patients with more aggressive breast cancer that over-expresses or amplifi es the HER2 gene [1][2][3][4] . Nevertheless, adverse effects of chemotherapy (CT) agents, including cardiotoxicity, have been more often observed and this can negatively affect both quality of life and outcome of patients from this group 1,3,5,6 . Trastuzumab (a monoclonal antibody targeting the HER2 gene) and paclitaxel (an antimicrotubule agent) have been employed with success to treat HER2 positive breast cancer [1][2][3]5 .…”

“…Nevertheless, adverse effects of chemotherapy (CT) agents, including cardiotoxicity, have been more often observed and this can negatively affect both quality of life and outcome of patients from this group 1,3,5,6 . Trastuzumab (a monoclonal antibody targeting the HER2 gene) and paclitaxel (an antimicrotubule agent) have been employed with success to treat HER2 positive breast cancer [1][2][3]5 . The incidence of cardiac adverse events associated with isolated use of trastuzumab ranges from 2 to 4% 1,3,5,7 ; and may increase up to 16% with previous use of anthracycline and/or cyclophosphamide 1,[3][4][5][6][7] .…”

“…Trastuzumab (a monoclonal antibody targeting the HER2 gene) and paclitaxel (an antimicrotubule agent) have been employed with success to treat HER2 positive breast cancer [1][2][3]5 . The incidence of cardiac adverse events associated with isolated use of trastuzumab ranges from 2 to 4% 1,3,5,7 ; and may increase up to 16% with previous use of anthracycline and/or cyclophosphamide 1,[3][4][5][6][7] . Trastuzumab has been administered in combination with placlitaxel to treat women who have not previously received CT for metastatic breast cancer 8 .…”

“…Trastuzumab has been administered in combination with placlitaxel to treat women who have not previously received CT for metastatic breast cancer 8 . Asymptomatic arrhythmias occur in association with the use of paclitaxel, and more severe cardiac adverse effects are related to CT schedules containing anthracyclines 1,3,6,9 . The concomitant use of trastuzumab and paclitaxel has been also associated with increased risk of cardiotoxicity 8 .…”

Single‐isocenter hybrid IMRT plans versus two‐isocenter conventional plans and impact of intrafraction motion for the treatment of breast cancer with supraclavicular lymph nodes involvement

“…3D CRT improves the local control, but normal tissue toxicity remains a concern 10 , 11 , 12 . Intensity‐modulated radiotherapy (IMRT) is an alternative technique to improve dose homogeneity and decrease normal tissue irradiation.…”