Cardiovascular toxicity in brest cancer patient: diagnosis, treatment, prevention

Main Article Content

S. M. Kozhukhov
N. V. Dovganich
I. I. Smolanka
O. F Ligirda
O. Ya. Yarynkina
O. M. Ivankova

Abstract

Over the past decades, the survival of breast cancer patients has significantly improved with advances in drug treatment and radiation therapy. Classical chemotherapy based primarily on anthracyclines, as well as targeted therapy and immunotherapy, have increased survival in breast cancer patients. However, both conventional chemotherapeutic agents and some new molecules can cause cardiovascular side effects that potentially worsen prognosis. The mechanisms of cardiovascular complications vary greatly depending on the drug type, and may manifest by temporary cardiomyocyte dysfunction or induce irreversible myocardial damage. Breast cancer patients are at high risk of cardiotoxicity because they receive combined cancer treatment and therefore require careful monitoring of heart function, especially with pre-existing cardiovascular diseases or multiple risk factors. Practically, it is possible due to close cooperation between cardiologists and oncologists, resulting in risk stratification of cardiovascular complications before antitumor treatment, individualized therapy, monitoring for early detection of complications, as well as timely use of cardioprotective therapy, both for prevention and treatment of complications that will improve survival and quality of life in breast cancer patients.

Article Details

Keywords:

breast cancer, cardiovascular toxicity, cardiomonitoring

References

Бюлетень Національного Канцерреєстру України № 20.– Київ, 2019.– 130 с.

Кожухов С.М., Довганич Н.В., Смоланка І.І. та ін. Стандарти надання медичної допомоги хворим із серцево-судинними ускладненнями внаслідок дії протипухлинних препаратів та променевої терапії. Серцево-судинні захворювання. Класифікація, стандарти діагностики та лікування / За ред. В.М. Коваленка, М.І. Лутая, Ю.М. Сіренка, О.С. Сичова.– 4-те вид., переробл. і доповн.– К.: Моріон, 2020.– С. 217–237.

Alexandre J., Cautela J., Ederhy S. et al. Cardiovascular Toxicity Related to Cancer Treatment: A Pragmatic Approach to the American and European CardioOncology Guidelines // J. Am. Heart Assoc.– 2020.– Vol. 9.– P. e018403. doi: https://doi.org/10.1161/JAHA.120.018403.

Armenian S.H., Lacchetti C., Barac A. et al. Prevention and monitoring of cardiac dysfunction in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline // J. Clin. Oncol.– 2017.– Vol. 35.– P. 893–911. doi: https://doi.org/10.1200/JCO.2016.70.5400.

Cardinale D., Ciceri F., Latini R. et al. ICOSONE Study Investigators. Anthracyclineinduced cardiotoxicity: A multicenter randomised trial comparing two strategies for guiding prevention with enalapril: The International CardioOncology Societyone trial // Eur. J. Cancer.– 2018.– Vol. 94.– P. 126–137.

Cardinale D., Colombo A., Bacchiani G. et al. Early detection of anthracycline cardiotoxicity and improvement with heart failure therapy // Circulation.– 2015.– Vol. 131.– P. 1981–1988.

Cardinale D., Colombo A., Torrisi R. et al. Trastuzumab induced cardiotoxicity: clinical and prognostic implications of Troponin I evaluation // J. Clin. Oncol.– 2010.– Vol. 28.– P. 3910–3916.

Cardinale D., Iacopo F., Cipolla C.M. Cardiotoxicity of Anthracyclines // Front. Cardiovasc. Med.– 2020.– Vol. 7.– P. 26. doi:https://doi.org/10.3389/fcvm.2020.00026.

Cardinale D., Sandri M.T., Martinoni A. et al. Myocardial injury revealed by plasma troponin I in breast cancer treatment with high dose chemotherapy // Ann. Oncol.– 2002.– Vol. 13.– P. 710–715. doi: https://doi.org/10.1093/annonc/mdf170.

Cardoso F., Senkus E., Costa A. et al. Clinical Practice Guidelines Slideset Advanced Breast Cancer; 2018. https://www.esmo.org/content/download/181639/3308758/file/ClinicalPracticeGuidelines SlidesetAdvancedBreastCancer.pdf. Accessed March 6, 2019.

Curigliano G., Cardinale D., Dent S. et al. Cardiotoxicity of anticancer treatments: epidemiology, detection, and management // CA Cancer J. Clin.– 2016.– Vol. 66.– Р. 309–325. doi: https://doi.org/10.3322/caac.21341.

Curigliano G., Lenihan D., Fradley M. et al. Management of cardiac disease in cancer patients throughout oncological treatment: ESMO consensus recommendations // Ann. Oncology.– 2020.– Vol. 31 (Issue 2). https://doi.org/10.1016/j.annonc.2019.10.023.

D’Souza M., Smedegaard L., Madelaire C. et al. Incidence of atrial fibrillation in conjunction with breast cancer // Heart Rhythm.– 2019.– Vol. 16 (3).– P. 343–348.

Darby S.C., Ewertz M., McGale P. et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer // New Engl. J. Med.– 2013.– Vol. 368.– Р. 987–998.

Debiasi M. et al. Efficacy of antiHER2 agents in combination with adjuvant or neoadjuvant chemotherapy for early and locally advanced HER2-positive breast cancer patients: a network metaanalysis // Front. Oncol.– 2018.– Vol. 8.– P. 156. doi: https://doi.org/10.3389/fonc.2018.00156.

Ewer M.S., Ewer S.M. Cardiotoxicity of anticancer treatments // Nat. Rev. Cardiol.– 2015.– Vol. 12.– Р. 620–625.

Ezaz G., Long J.B., Gross C.P., Chen J. Risk prediction model for heart failure and cardiomyopathy after adjuvant trastuzumab therapy for breast cancer // J. Am. Heart Assoc.– 2014.– Vol. 3 (1).– P. e000472. doi: https://doi.org/10.1161/JAHA.113.000472.

Finn R.S., Aleshin A., Slamon D.J. Targeting the cyclindependent kinases (CDK) 4/6 in estrogen receptorpositive breast cancers // Breast Cancer. Res.– 2016.– Vol. 18 (1).– P. 17.

Guenancia C., Lefevbvre A., Cardinale D. et al. Obesity as a risk factor for anthracyclines and trastuzumab cardiotoxicity in breast cancer: a systematic review and metaanalysis // J. Clin. Oncol.– 2016.– Vol. 34 (26).– Р. 3157–3165. doi: https://doi.org/10.1200/JCO.2016.67.4846.

Gulati G., Heck S.L., Ree A.H. et al. Prevention of cardiac dysfunction during adjuvant breast cancer therapy (PRADA): a 2 × 2 factorial, randomized, placebo controlled, doubleblind clinical trial of candesartan and metoprolol // Eur. Heart J. – 2016.– Vol. 37.– P. 1671–1680.

Hamo C.E., Bloom M.W., Cardinale D. et al. Cancer therapyrelated cardiac dysfunction and heart failure: Part 2: prevention, treatment, guidelines, and future directions // Circ. Heart Fail.– 2016.– Vol. 9.– P. e002843.

Herrmann J., Lerman A., Sandhu N.P. et al. Evaluation and management ofpatients with heart disease and cancer: cardiooncology // Mayo Clin. Proc.– 2014.– Vol. 89.– P. 1287–1306.

Jacot W. et al. Efficacy and safety of trastuzumab emtansine (TDM1) in patients with HER2positive breast cancer with brain metastases // Breast Cancer. Res. Treat.– 2016.– Vol. 157.– P. 307–318. doi: https://doi.org/10.1007/s1054901638286.

Kalay N., Basar E., Ozdogru I. et al. Protective effects of carvedilol against anthracyclineinduced cardiomyopathy // J. Am. Coll. Cardiol.– 2006.– Vol. 48.– P. 2258–2262. doi: https://doi.org/10.1016/j.jacc.2006.07.052.

Kaya M.G., Ozkan M., Gunebakmaz O. et al. Protective effects of nebivolol against anthracyclineinduced cardiomyopathy: a randomized control study // Int. J. Cardiol.– 2013.– Vol. 167 (5).– Р. 2306–2310. doi: https://doi.org/10.1016/j.ijcard.2012.06.023.

Key N.S., Khorana A.A., Kuderer N.M. et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO Clinical Practice Guideline Update // J. Clin. Oncol.– 2019.– JCO1901461.

Khouri M.G., Douglas P.S., Mackey J.R. et al. Cancer therapy induced cardiac toxicity in early breast cancer: addressing the unresolved issues // Circulation.– 2012.– Vol. 26.– Р. 2749–2763. doi: https://doi.org/10.1161/CIRCULATIONAHA.112.100560.

Kozhukhov S., Dovganych N., Smolanka I., Lyhyrdа O. Cardiooncology in Ukraine: experience at Strazhesko Institute of Cardiology // Onco Review.– 2018.– Vol. 8, N 3.– P. A65–A69.

Lancellotti P., Nkomo V.T, Badano L.P. et al. Expert Consensus for MultiModality Imaging Evaluation of Cardiovascular Complications of Radiotherapy in Adults: A Report from the European Association of Cardiovascular Imaging and the American Society of Echocardiography // Eur. Heart J. Cardiovasc. Imaging.– 2013.– Vol. 114 (8).– Р. 721–740. doi: https://doi.org/10.1093/ehjci/jet123.

López Sendón J., Álvarez Ortega C., Zamora Auñon P. et al. Classification, prevalence, and outcomes of anticancer therapyinduced cardiotoxicity: the CARDIOTOX registry // Eur. Heart J.– 2020.– Vol. 41.– P. 1720–1729.

Lyon A.R., Dent S., Stanway S. et al. Baseline cardiovascular risk assessment in cancer patients scheduled to receive cardiotoxic cancer therapies: a position statement and new risk assessment tools from the CardioOncology Study Group of the Heart Failure Association of the European Society of Cardiology in collaboration with the International CardioOncology Society // Eur. J. Heart Failure.– 2020. doi: https://doi.org/10.1002/ejhf.1920.

Macedo A.V.S., Lyon A.R., Nascimento B.R. et al. Efficacy of dexrazoxane in preventing anthracycline cardiotoxicity in breast cancer // J. Am. Coll. Cardiol. CardioOnc.– 2019.– Vol. 1.– P. 68–79. doi: https://doi.org/10.1016/j.jaccao.2019.08.003.

Paiva Р.F., Soares A.A., Pinheiro G.S. et al. Heart valve injury induced by mediastinum radiotherapy in cancer treatment // J. Pharmacy Pharmacology.– 2018.– Vol. 6.– P. 578–586. doi: https://doi.org/10.17265/23282150/2018.06.004.

Pandey A.K., Singhi E.K., Arroyo J.P. et al. Mechanisms of VEGF (vascular endothelial growth factor) inhibitorasso­­ciated hypertension and vascular disease // Hypertension. 2018.– Vol. 71.– P. e1–e8. doi: https://doi.org/10.1161/HYPERTENSIONAHA.117.10271.

Pareek N., Cevallos J., Moliner P. et al. Activity and outcomes of a cardiooncology service in the United Kingdom – a five-year experience // Eur. J. Heart Fail.– 2018.– Vol. 20.– P. 1721–1731. doi: https://doi.org/10.1002/ejhf.1292.

Parent S., Pituskin E., Paterson D.I. The cardiooncology program: a multidisciplinary approach to the care of cancer patients with сardiovascular disease // Can. J. Cardiol.– 2016.– Vol. 32.– P. 847–851. doi: https://doi.org/10.1016/j.cjca.2016.04.014.

Perez E.A., Barrios C., Eiermann W. et al. Trastuzumab emtansine with or without pertuzumab versus trastuzumab plus taxane for human epidermal growth factor receptor 2 positive, advanced breast cancer: primary results from the phase III MARIANNE Study // J. Clin. Oncol.– 2017.– Vol. 35.– P. 141–148. doi: https://doi.org/10.1200/JCO.2016.67.4887.

Perez E.A., Suman V.J., Davidson N.E. et al. Cardiac safety analysis of doxorubicin and cyclophosphamide in the North Central Cancer Treatment Group Adjuvant Breast Cnacner Trial // J. Clin. Oncol. – 2008.– Vol. 26.– Р. 1231–1238.

Pituskin E., Mackey J.R., Koshman S. et al. Multidisciplinary Approach to Novel Therapies in CardioOncology Research (MANTICORE 101Breast): A Randomized Trial for the Prevention of Trastuzumab Associated Cardiotoxicity // J. Clin. Oncol.– 2017.– Vol. 35 (8).– Р. 870–877. doi: https://doi.org/10.1200/JCO.2016.68.7830.

Plana J.C., Galderisi M., Barac A. et al. Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging // Eur. Heart J. Cardiovasc. Imaging.– 2014.– Vol. 15.– P. 1063–1093.

Ponikowski P., Voors A.A., Anker S.D. et al. ESC Scientific Document Group. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure // Eur. Heart J.– 2016.– Vol. 37 (27).– Р. 2129–2200. doi: https://doi.org/10.1093/eurheartj/ehw128.

Rafiyath S.M., Rasul M., Lee B. et al. Comparison of safety and toxicity of liposomal doxorubicin vs. conventional anthracyclines: a meta-analysis // Exp. Hematol. Oncol.– 2012.– Vol. 1.– P. 10.

Rochette L., Guenancia C., Gudjoncik A. et al. Anthra­­­cyclines/trastuzumab: new aspects of cardiotoxicity and molecular mechanisms // Trends. Pharmacol. Sci.– 2015.– Vol. 36 (6).– Р. 326–348. doi: https://doi.org/10.1016/j.tips.2015.03.005.

Sawyer D.B., Peng X., Chen B. et al. Mechanisms of anthracycline cardiac injury: can we identify strategies for cardioprotection? // Prog. Cardiovasc. Dis.– 2010.– Vol. 53.– Р. 105–113.

Seicean S., Seicean A., Alan N. et al. Cardioprotective effect of ß-adrenoceptor blockade in patients with breast cancer undergoing chemotherapy: follow-up study of heart failure // Circ. Heart Fail.– 2013.– Vol. 6 (3).– Р. 420–426. doi: https://doi.org/10.1161/CIRCHEARTFAILURE.112.000055.

Shao N., Wang S., Yao C. et al. Sequential versus concurrent anthracyclines and taxanes as adjuvant chemotherapy of early breast cancer: a meta-analysis of phase III randomized control trials. // Breast.– 2012.– Vol. 21.– Р. 389–393.

Smith L.A., Cornelius V.R., Plummer C.J. et al. Cardiotoxicity of anthracycline agents for the treatment of cancer: systematic review and meta-analysis of randomised controlled trials. // BMC Cancer.– 2010.– Vol. 10.– Р. 337–338.

Swain S.M., Whaley F.S., Ewer M.S. Congestive heart failure in patients treated with doxorubicin: a retrospective analysis of three trials // Cancer.– 2003.– Vol. 97.– Р. 2869–2879.

Thavendiranathan P., Poulin F., Lim K.D. et al. Use of Myocardial Strain Imaging by Echocardiography for the Early Detection of Cardiotoxicity in Patients During and After Cancer Chemotherapy A Systematic Review // J. Am. Coll. Cardiol.– 2014.– Vol. 63.– P. 2751–2768.

Wang D.Y., Okoye G.D., Neilan T.G. et al. Cardiovascular toxicities associated with cancer immunotherapies // Curr. Cardiol. Rep.– 2017.– Vol. 19.– P. 21. doi: https://doi.org/10.1007/s1188601708350.

Zamorano J.L., Lancellotti P., Rodriguez Muñoz D. et al.; ESC Scientific Document Group. 2016 ESC position paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: the Task Force for Cancer Treatments and Cardiovascular Toxicity of the European Society of Cardiology (ESC) // Eur. Heart J.– 2016.– Vol. 37.– Р. 2768–2801. doi: https://doi.org/10.1093/eurheartj/ehw211.

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