Chemotherapy-Induced Cardiotoxicity in Women

doi:10.1016/j.hfc.2011.04.004

Heart Failure Clinics

Volume 7, Issue 3, July 2011, Pages 427-435

https://doi.org/10.1016/j.hfc.2011.04.004 Get rights and content

Chemotherapy-induced cardiotoxicity (CIC) is a major complication found with some life-saving medications used to treat breast and other cancers. Cardiotoxicity may present immediately during treatment or years later. These patients need education, screening, preventive measures, prompt interventions, and proper follow-up. This article focuses on CIC in patients who have breast cancer, but the process of evaluation and treatment design applies to all types of cancer and organ toxicities. Comprehensive pretreatment history, examination, and testing are needed for proper diagnosis and staging. CIC and other toxicities need to be considered in drug selection, treatment sequencing, testing, and appropriate follow-up.

Section snippets

Chemotherapy-induced cardiotoxicity

Cardiotoxicity is defined as a poisonous or deleterious effect upon the heart.⁷ CIC is cardiotoxicity that develops as a result of chemotherapy administration. CIC can manifest on a continuum ranging from asymptomatic, transient arrhythmias to fatal cardiomyopathy resulting from permanent left ventricular dysfunction. CIC may occur acutely during treatment or years later and varies for different chemotherapy drugs.⁸ Table 1 summarizes the cardiotoxic manifestations of various chemotherapy

Evaluation

The general model for the evaluation and treatment of CIC is similar to that used to evaluate and design treatment regimens for patients who have breast cancer. An oncologist typically is consulted to see a patient who has a known diagnosis of breast cancer, often after biopsy and/or surgical intervention. To help guide prognosis and treatment choices, the oncology evaluation includes determination of the stage, grade, hormone receptor, and HER2 status of the tumor.¹¹

The treatment and prognosis

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Citation Excerpt :
Binding of the antibody blocks downstream intracellular tyrosine kinase activity, and patients with HER2-positive breast cancer who receive trastuzumab after standard chemotherapy have significantly improved outcomes [27,28]. When administered as a single agent, trastuzumab leads to decreased left ventricular ejection fraction and heart failure in up to 7%–10% of patients [29,30]. The mechanism of cardiotoxicity is attributed to the role of myocyte HER2 activation for normal repair mechanisms during stress responses [25].
In the United States, the lifetime risk of a cancer diagnosis is nearly 40%; in 2016, that represents almost 1.6 million new patients, and despite advances in early diagnosis and treatment, roughly 35% will ultimately die of their malignancy. Fortunately, the number of patients living with a cancer diagnosis also continues to expand, anticipated to be more than 19 million in less than a decade. In calculating the relative risks and benefits of therapy, it is therefore important to consider the morbidity and mortality associated with antitumor therapy itself. Significantly, excluding demise due to the malignancy itself, treatment-induced adverse cardiovascular events are the leading cause of death in cancer patients. Chemotherapy, targeted therapies, immune checkpoint inhibition, and radiation therapy can all adversely impact cardiac function, and their effects can be synergistic. Consequently, it is important that possible side effects of therapy be recognized and effectively controlled. This review highlights the mechanisms and histopathologic findings associated with common forms of potentially cardiotoxic cancer therapy including anthracyclines, tyrosine kinase inhibitors, and most recently immune checkpoint (PD-1) inhibitors. Although for many cases the histologic findings are nonspecific, in the appropriate clinical context, therapeutic cardiotoxicity can be inferred and the treatment approach refined appropriately.
Cardiotoxicity associated with tyrosine kinase-targeted anticancer therapy
2018, Molecular and Cellular Toxicology
Cardiovascular Risk in Cancer Survivors
2018, Current Treatment Options in Cardiovascular Medicine
Assessment of chemotherapy on various biochemical markers in breast cancer patients
2018, Journal of Cellular Biochemistry
Cardiotoxicity of Anticancer Therapeutics
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Pregnancy after fertility preservation
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: This article originally appeared in Critical Care Nursing Clinics of North America, volume 20, number 3.

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Special ArticleChemotherapy-Induced Cardiotoxicity in Women

Section snippets

Chemotherapy-induced cardiotoxicity

Evaluation

Cancer statistics 2007

About breast cancer: statistics, causes, symptoms, surgery options

Facts for life breast cancer in men. Susan G. Komen for the Cure Web site

Surveillance Epidemiology and End Results Program

Multiple hit hypothesis: how breast cancer treatment affects heart disease in women. Her2 Support Group Forum Web site

Cardiovascular complications of cancer therapy: diagnosis, pathogenesis, and management

Circulation

Miller-Keane encyclopedia and dictionary of medicine, nursing, and allied health

Adriamycin [package insert]

Fundamentals of nursing concepts process and practice

The Merck manual