Prevention, Detection, and Management of Heart Failure in Patients Treated for Breast Cancer

Agneta Månsson Broberg, Jürgen Geisler, Suvi Tuohinen, Tanja Skytta, Þórdís Jóna Hrafnkelsdóttir, Kirsten Melgaard Nielsen, Elham Hedayati, Torbjørn Omland, Birgitte V. Offersen, Alexander R. Lyon, Geeta Gulati

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Purpose of Review: Long-term survival has increased significantly in breast cancer patients, and cardiovascular side effects are surpassing cancer-related mortality. We summarize risk factors, prevention strategies, detection, and management of cardiotoxicity, with focus on left ventricular dysfunction and heart failure, during breast cancer treatment. Recent Findings: Baseline treatment of cardiovascular risk factors is recommended. Anthracycline and trastuzumab treatment constitute a substantial risk of developing cardiotoxicity. There is growing evidence that this can be treated with beta blockers and angiotensin antagonists. Early detection of cardiotoxicity with cardiac imaging and circulating cardiovascular biomarkers is currently evaluated in clinical trials. Chest wall irradiation accelerates atherosclerotic processes and induces fibrosis. Immune checkpoint inhibitors require consideration for surveillance due to a small risk of severe myocarditis. Cyclin-dependent kinases4/6 inhibitors, cyclophosphamide, taxanes, tyrosine kinase inhibitors, and endocrine therapy have a lower-risk profile for cardiotoxicity. Summary: Preventive and management strategies to counteract cancer treatment–related left ventricular dysfunction or heart failure in breast cancer patients should include a comprehensive cardiovascular risk assessment and individual clinical evaluation. This should include both patient and treatment-related factors. Further clinical trials especially on early detection, cardioprevention, and management are urgently needed.

Original languageEnglish
Pages (from-to)397-408
Number of pages12
JournalCurrent Heart Failure Reports
Volume17
Issue number6
DOIs
Publication statusPublished - 2020
Publication typeA1 Journal article-refereed

Keywords

  • Anthracyclines
  • Breast cancer
  • Cardiotoxicity
  • Heart failure
  • Radiation therapy
  • Trastuzumab

Publication forum classification

  • Publication forum level 0

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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