Key result
Neoadjuvant PTD and LMWH bridging achieve complete response without cardiovascular complications in a high-risk case.
Why the study?
Anticancer agent cardiovascular toxicity is a critical concern, especially in elderly patients with pre-existing cardiovascular comorbidities who require careful perioperative antithrombotic management and surveillance for cardiovascular complications.
Case Report (n=1)
No
Answers are grounded in this paper and cite their sources.
For high-risk breast cancer patients with cardiovascular comorbidities, a multidisciplinary approach with low-cardiotoxicity regimens and rigorous monitoring can safely balance oncological efficacy and cardiovascular safety.
Background As breast cancer treatment advances, therapeutic efficacy has improved significantly, but cardiovascular toxicity from anticancer agents has become a critical concern. Elderly patients often have pre-existing cardiovascular comorbidities like coronary heart disease (CHD) and high venous thromboembolism (VTE) risk, requiring long-term antithrombotic therapy. Perioperative management demands individualized assessment of thrombotic and bleeding risks, with bridging anticoagulation when necessary. Close surveillance for cardiovascular complications (myocardial injury, heart failure, hypertension [HTN]) and control of modifiable risk factors (HTN, diabetes mellitus [DM]) are essential during treatment. Case report This study presents a breast cancer patient with multiple cardiovascular comorbidities (HTN, DM, CHD). Following multidisciplinary team (MDT) consultation, the low-cardiotoxicity PTD regimen (pertuzumab, trastuzumab, docetaxel) was selected. Perioperatively, aspirin was withheld, and low-molecular-weight heparin (LMWH) bridging was used 24 h before and after radical mastectomy. Postoperative radiotherapy was administered, with regular cardiac function monitoring throughout treatment. No cardiovascular complications occurred. Conclusion For cancer patients with cardiovascular comorbidities, balancing tumor treatment and cardiovascular safety is achievable through comprehensive baseline risk assessment, the selection of low-cardiotoxicity regimens, rational perioperative antithrombotic adjustments, and continuous cardiac monitoring, thereby ensuring optimal oncological outcomes with minimized cardiovascular risks.
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Long et al. (2026) conducted a case report in HER2-positive breast cancer with cardiovascular comorbidities (n=1). PTD regimen (pertuzumab, trastuzumab, docetaxel) and LMWH bridging was evaluated on Cardiovascular complications and pathological response. Neoadjuvant therapy with the PTD regimen and perioperative LMWH bridging achieved a pathological complete response without cardiovascular complications in a high-risk breast cancer patient.
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