Prevalence and Effects of Late Cardiotoxicity induced by Anthracyclines and/or Anti- HER2 Antibodies in Patients with Breast Cancer: a real world study

Introduction: Breast cancer (BC) is the most frequently diagnosed cancer and the leading cause of cancer-related mortality in women. Advances in screening and treatment have improved survival but have also increased morbidity and mortality due to treatment side effects, particularly cardiotoxicity. Late cardiotoxicity generally develops several years after treatment. The risk of cardiotoxicity post BC treatment is increased by cardiovascular (CV) risk factors and previous cardiac disease. Nevertheless, limited data is available about the long-term effects of cardiotoxic treatment in women without CV risk factors before BC diagnosis. Aims: To assess prevalence and long-term effects of late cardiotoxicity in a low-risk group of BC survivors. Methods: This prospective study evaluated women aged between 18–65 years, diagnosed with non-metastatic BC and treated between 2011–2016 at a single institution The echocardiographic parameters were compared to an age-matched control group of women recently diagnosed with BC who have not been submitted to anticancer therapy. Results: Among the 40 recruited women, 32.5% displayed left ventricular systolic dysfunction (LVSD) and 10% fulfilled criteria for late cardiotoxicity based on their previously recorded imaging parameters. There was a significant difference in left ventricular ejection fraction (LVEF) between time points (p < .001). The study group had significant lower LVEF compared to the control group, (p < .001). Additionally, there was a significant reduction in Global Longitudinal Strain in the study group when compared to controls, (p < .001). Conclusions: In conclusion, this study demonstrated that cancer therapy related cardiac disease is a common side effect in BC survivors. Given this finding, even women without previous CV risk factors should be carefully monitored years after the end of treatment.