Breast cancer treatment-related cardiovascular disturbances: advocacy for a watchful attitude in this never-ending story

ABSTRACT

Introduction

Thanks to the emergence of new therapeutics, prognosis and outcome of breast cancer patients (any subtype) have improved significantly. This raises the issue of the interactions and side effects related to the use of multiple drugs. Thus, to decide on a treatment, the optimal benefit risk-ratio should be carefully watched as toxicities such as cardiac ones effect on long-term survival. Indeed, nowadays in France, cardiovascular diseases rank first as causes of death in women.

Areas covered

This non-exhaustive review aims to report the currently available data on cardiac side effects caused by the use of emerging drugs in breast cancer, in localized or metastatic diseases alike. We will focus on HER2-inhibitors, cyclin-dependent-kinase 4/6 and PARP inhibitors, chemotherapy and immunotherapy, before discussing the means of prevention.

Expert opinion

Although this issue has largely been studied, the recent emergence of new drugs emphasizes the necessity for oncologists to adapt their practice to a multidisciplinary model that includes cardio-oncology.

KEYWORDS:

• Breast cancer
• cardiotoxicity
• cardio-oncology
• CDK 4/6 inhibitors
• chemotherapy
• immunotherapy
• HER2 inhibitors
• parp inhibitors

Article highlights

• The survival gains from the use of new systemic therapeutics are counterbalanced by the occurrence of side effects since cardiac diseases have become the leading cause of death in former breast cancer patients.

• The issue of the interactions and side effects related to the use of multiple drugs has been raised.

• The challenge now consists in combining the usual toxicity data with those related to the use of emergent drugs while integrating the supposed benefits of the treatment and adapting patients’ specific characteristics to achieve a ‘personalized medicine.’

• In the future, oncologists will have to study physiopathological processes in order to propose clinical prevention strategies.

• We advocate for a multidisciplinary approach and an integrative vision through cardio-oncology to optimize the care of breast cancer patients.

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded.