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

Sergiu Ioan Murg; Loredana Matiș; Andrada Florina Moldovan; Andrada Florina Schwarz-Madar; Daniela Florina Trifan; Timea Claudia Ghitea; Mircea Ioachim Popescu

doi:10.3390/cancers16244281

December 23, 2024CancersOpen Access

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

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Why the study?

Advancements in cancer treatments improve survival but increase cardiovascular risks, requiring evaluation of cardiotoxic effects and their relationship to tumor characteristics to improve prevention and management.

Do anthracyclines and HER2-targeted therapies cause cardiotoxicity in breast cancer patients?

Key Points

To evaluate the cardiotoxic effects of cytostatic treatments and examine how tumor histopathology and TNM staging relate to cardiovascular complications in cancer patients.
Retrospectively analyzed cancer patients treated with anthracyclines, HER2-targeted therapies, and radiotherapy.
Assessed cardiac function through echocardiography (left ventricular ejection fraction and global longitudinal strain) and evaluated blood biomarkers including cardiac troponins and natriuretic peptides.
Stratified patients according to histopathology and TNM cancer stages to evaluate cardiovascular vulnerability.
Anthracycline regimens and HER2-targeted therapies were significantly associated with reductions in left ventricular ejection fraction, particularly among patients with advanced cancer stages.
Elevations in cardiac troponins and natriuretic peptides signaled subclinical cardiotoxicity before the onset of overt clinical symptoms.
Patients presenting with pre-existing cardiovascular risk factors experienced a higher overall prevalence of treatment-related cardiac complications.

Structured PICO

Do anthracyclines and HER2-targeted therapies cause cardiotoxicity in breast cancer patients?

P

Population

Breast cancer patients treated with anthracyclines, HER2-targeted therapies, and radiotherapy

I

Intervention

Anthracyclines, HER2-targeted therapies, and radiotherapy

O

Outcome

Cardiotoxicity measured by reduction in left ventricular ejection fraction (LVEF) and subclinical cardiotoxicity detected by cardiac troponins and natriuretic peptidessurrogate

Anthracyclines and HER2-targeted therapies are associated with reduced LVEF and early biomarker signs of cardiotoxicity in breast cancer patients, emphasizing the need for regular cardiac monitoring.

Implication

Observational links between anthracyclines/HER2 therapies and LVEF decline in advanced breast cancer support early biomarker monitoring; leaves causal effects and prevention open.

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).