Cardiac risk in the treatment of breast cancer: assessment and management

Figures & data

Table 1 Assessment, monitoring, and management of cardiac toxicity due to breast cancer treatment

Cancer treatment	Assessment/monitoring			Prevention		Treatment
	Current recommendations		Under investigation	Recommended strategies	Under investigation
	Imaging	Other
Radiotherapy	Conventional imaging technique at baseline^Citation9 Conventional imaging as monitoring at 10 years after radiotherapy (at 5 years in high-risk patients) and then every 5 years^Citation9	Baseline evaluation of risk factors^Citation9,Citation91 Adequate management of cardiovascular risk factors^Citation9,Citation91	TDI 3D echocardiography Cardiac MRI Serum cardiac biomarkers	Modern RT techniques to minimize heart dose (3D conformal RT, IMRT, ABC)	Statins ACE-i/ARB	ACE-i/ARB heart failure) Beta-blockers Diuretics (symptomatic heart failure)
Anthracyclines	Conventional imaging technique at baseline^Citation91,Citation92 Conventional imaging as monitoring (3, 6, 9, 12, 18 months^Citation91 or at the completion of treatment and 6 months later^Citation92)	Baseline evaluation of risk factors^Citation91,Citation92 Adequate management of cardiovascular risk factors^Citation91,Citation92 Serum cardiac biomarkers (troponin^Citation92 or troponin plus BNP^Citation91) may be useful at baseline and for monitoring	TDI 3D echocardiography Cardiac MRI Serum cardiac biomarkers	Approaches to reduce risk for anthracycline-induced cardiotoxicity (avoid excess cumulative dose, prefer infusion instead of bolus, use of non-anthracycline-based chemotherapy)	Approaches to reduce risk for anthracycline-induced cardiotoxicity (use of liposomally encapsulated anthracyclines in adjuvant setting) Dexrazoxane Statins Beta-blockers ACE-i/ARB Aerobic exercise	ACE-i/ARB Beta-blockers Diuretics (symptomatic heart failure)
Trastuzumab	Conventional imaging technique at baseline^Citation91,Citation92 Conventional imaging as monitoring (3, 6, 9, 12, 18 months^Citation91 or every 3 months during therapy and 6 months later for those who had previously received anthracyclines^Citation92)	Baseline evaluation of risk factors Adequate management of cardiovascular risk factors Serum cardiac biomarkers (troponin^Citation92 or troponin plus BNP^Citation91) may be useful at baseline and for monitoring	TDI 3D echocardiography Cardiac MRI Serum cardiac biomarkers	–	Beta-blockers ACE-i/ARB	ACE-i/ARB Beta-blockers Diuretics (symptomatic heart failure)

Note: The recommendations are based on guidelines from ESMO⁹¹ and American Society of Echocardiography/European Association of Cardiovascular Imaging⁹² guidelines.

Abbreviations: ABC, active breathing control; ACE-i, angiotensin-converting enzyme inhibitors; ARB, angiotensin receptor blockers; BNP, B-type natriuretic peptide; IMRT, intensity-modulated radiotherapy; MRI, magnetic resonance imaging; RT, radiotherapy; TDI, tissue Doppler imaging.

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