Skip to main content
Top
Published in:

21-04-2025 | Anthracycline | REVIEW

Cardio-Oncology and Breast Cancer Therapies

Authors: Rohit Singh, Krina Patel, Haze Xu, Aderonke Adeniyi, Jenica N. Upshaw, Peter Van Buren, Peter A. Kaufman, Kim Dittus, Kara K. Landry

Published in: Current Treatment Options in Oncology | Issue 5/2025

Login to get access

Opinion Statement

Assessing cardiac risk prior to initiating breast cancer treatment, monitoring cardiac function during treatment, and implementing appropriate follow-up strategies are essential components of managing cardiotoxicity in breast cancer patients. A comprehensive cardiovascular evaluation should be conducted before treatment, including a detailed medical history, physical examination, and baseline cardiac imaging. Risk stratification tools can aid in determining the individual patient's risk profile. Close monitoring of cardiac function, including regular assessment of left ventricular ejection fraction (LVEF) and monitoring for signs and symptoms of cardiac dysfunction, is crucial during treatment. Prompt action should be taken if an adverse cardiovascular event is detected, including considering discontinuing or modifying the treatment regimen. Appropriate follow-up care is essential to monitor for long-term cardiac effects and optimize cardiovascular health in breast cancer survivors. Regular cardiovascular assessments, lifestyle modifications, and collaboration between healthcare professionals are important in managing cardiotoxicity effectively.
Literature
1.
go back to reference 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines | Circulation. Accessed June 18, 2024. https://www.ahajournals.org/doi/https://doi.org/10.1161/CIR.0000000000001063 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines | Circulation. Accessed June 18, 2024. https://​www.​ahajournals.​org/​doi/​https://​doi.​org/​10.​1161/​CIR.​0000000000001063​
2.
go back to reference Lyon AR, López-Fernández T, Couch LS, et al. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J. 2022;43(41):4229–361. https://doi.org/10.1093/eurheartj/ehac244.CrossRefPubMed Lyon AR, López-Fernández T, Couch LS, et al. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J. 2022;43(41):4229–361. https://​doi.​org/​10.​1093/​eurheartj/​ehac244.CrossRefPubMed
27.
go back to reference Bonneterre J, Roché H, Kerbrat P, et al. Long-term cardiac follow-up in relapse-free patients after six courses of fluorouracil, epirubicin, and cyclophosphamide, with either 50 or 100 mg of epirubicin, as adjuvant therapy for node-positive breast cancer: French adjuvant study group. J Clin Oncol. 2004;22(15):3070–9. https://doi.org/10.1200/JCO.2004.03.098.CrossRefPubMed Bonneterre J, Roché H, Kerbrat P, et al. Long-term cardiac follow-up in relapse-free patients after six courses of fluorouracil, epirubicin, and cyclophosphamide, with either 50 or 100 mg of epirubicin, as adjuvant therapy for node-positive breast cancer: French adjuvant study group. J Clin Oncol. 2004;22(15):3070–9. https://​doi.​org/​10.​1200/​JCO.​2004.​03.​098.CrossRefPubMed
48.
go back to reference Amir E, Seruga B, Niraula S, Carlsson L, Ocana A. Toxicity of adjuvant endocrine therapy in postmenopausal breast cancer patients: a systematic review and meta-analysis. In: Database of Abstracts of Reviews of Effects (DARE): Quality-Assessed Reviews [Internet]. Centre for Reviews and Dissemination (UK); 2011. Accessed July 19, 2024. https://www.ncbi.nlm.nih.gov/books/NBK82853/ Amir E, Seruga B, Niraula S, Carlsson L, Ocana A. Toxicity of adjuvant endocrine therapy in postmenopausal breast cancer patients: a systematic review and meta-analysis. In: Database of Abstracts of Reviews of Effects (DARE): Quality-Assessed Reviews [Internet]. Centre for Reviews and Dissemination (UK); 2011. Accessed July 19, 2024. https://​www.​ncbi.​nlm.​nih.​gov/​books/​NBK82853/​
49.
go back to reference Baum M, Buzdar A, Cuzick J, Forbes J, Houghton J, Klijin J. Anastrozole alone or in combination with tamoxifen versus tamoxifen alone for adjuvant treatment of postmenopausal women with early breast cancer: first results of the ATAC randomised trial. Lancet. 2002;359:2131–9.CrossRefPubMed Baum M, Buzdar A, Cuzick J, Forbes J, Houghton J, Klijin J. Anastrozole alone or in combination with tamoxifen versus tamoxifen alone for adjuvant treatment of postmenopausal women with early breast cancer: first results of the ATAC randomised trial. Lancet. 2002;359:2131–9.CrossRefPubMed
50.
go back to reference Vogel VG. The NSABP Study of Tamoxifen and Raloxifene (STAR) trial [published correction appears in Expert Rev Anticancer Ther. 2009 Mar;9(3):388]. Expert Rev Anticancer Ther. 2009;9(1):51–60. Vogel VG. The NSABP Study of Tamoxifen and Raloxifene (STAR) trial [published correction appears in Expert Rev Anticancer Ther. 2009 Mar;9(3):388]. Expert Rev Anticancer Ther. 2009;9(1):51–60.
55.
65.
68.
go back to reference Thein KZ, Htut TW, Ball S, Swarup S, Sultan A, Oo TH. Venous thromboembolism risk in patients with hormone receptor-positive HER2-negative metastatic breast cancer treated with combined CDK 4/6 inhibitors plus endocrine therapy versus endocrine therapy alone: a systematic review and meta-analysis of randomized controlled trials. Breast Cancer Res Treat. 2020;183(2):479–87. https://doi.org/10.1007/s10549-020-05783-3.CrossRefPubMed Thein KZ, Htut TW, Ball S, Swarup S, Sultan A, Oo TH. Venous thromboembolism risk in patients with hormone receptor-positive HER2-negative metastatic breast cancer treated with combined CDK 4/6 inhibitors plus endocrine therapy versus endocrine therapy alone: a systematic review and meta-analysis of randomized controlled trials. Breast Cancer Res Treat. 2020;183(2):479–87. https://​doi.​org/​10.​1007/​s10549-020-05783-3.CrossRefPubMed
74.
go back to reference Lyon A. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS): Developed by the task force on cardio-oncology of the European Society of Cardiology (ESC). https://doi.org/10.1093/eurheartj/ehac244 Lyon A. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS): Developed by the task force on cardio-oncology of the European Society of Cardiology (ESC). https://​doi.​org/​10.​1093/​eurheartj/​ehac244
75.
76.
go back to reference Rugo HS, Huober J, García-Sáenz JA, et al. Management of Abemaciclib-Associated Adverse Events in Patients with Hormone Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative Advanced Breast Cancer: Safety Analysis of MONARCH 2 and MONARCH 3. Oncologist. 2021;26(1):e53–65. https://doi.org/10.1002/onco.13531.CrossRefPubMed Rugo HS, Huober J, García-Sáenz JA, et al. Management of Abemaciclib-Associated Adverse Events in Patients with Hormone Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative Advanced Breast Cancer: Safety Analysis of MONARCH 2 and MONARCH 3. Oncologist. 2021;26(1):e53–65. https://​doi.​org/​10.​1002/​onco.​13531.CrossRefPubMed
79.
go back to reference Ganz PA, Romond EH, Cecchini RS, et al. Long-Term Follow-Up of Cardiac Function and Quality of Life for Patients in NSABP Protocol B-31/NRG Oncology: A Randomized Trial Comparing the Safety and Efficacy of Doxorubicin and Cyclophosphamide (AC) Followed by Paclitaxel With AC Followed by Paclitaxel and Trastuzumab in Patients With Node-Positive Breast Cancer With Tumors Overexpressing Human Epidermal Growth Factor Receptor 2. JCO. 2017;35(35):3942–8. https://doi.org/10.1200/JCO.2017.74.1165.CrossRef Ganz PA, Romond EH, Cecchini RS, et al. Long-Term Follow-Up of Cardiac Function and Quality of Life for Patients in NSABP Protocol B-31/NRG Oncology: A Randomized Trial Comparing the Safety and Efficacy of Doxorubicin and Cyclophosphamide (AC) Followed by Paclitaxel With AC Followed by Paclitaxel and Trastuzumab in Patients With Node-Positive Breast Cancer With Tumors Overexpressing Human Epidermal Growth Factor Receptor 2. JCO. 2017;35(35):3942–8. https://​doi.​org/​10.​1200/​JCO.​2017.​74.​1165.CrossRef
83.
go back to reference Mavroudis D, Saloustros E, Malamos N, et al. Six versus 12 months of adjuvant trastuzumab in combination with dose-dense chemotherapy for women with HER2-positive breast cancer: a multicenter randomized study by the Hellenic Oncology Research Group (HORG). Ann Oncol. 2015;26(7):1333–40. https://doi.org/10.1093/annonc/mdv213.CrossRefPubMed Mavroudis D, Saloustros E, Malamos N, et al. Six versus 12 months of adjuvant trastuzumab in combination with dose-dense chemotherapy for women with HER2-positive breast cancer: a multicenter randomized study by the Hellenic Oncology Research Group (HORG). Ann Oncol. 2015;26(7):1333–40. https://​doi.​org/​10.​1093/​annonc/​mdv213.CrossRefPubMed
87.
go back to reference Pertuzumab, Trastuzumab, and Docetaxel in HER2-Positive Metastatic Breast Cancer | New England Journal of Medicine. Accessed May 22, 2024. https://www-nejm-org.ezproxy.uvm.edu/doi/full/https://doi.org/10.1056/NEJMoa1413513 Pertuzumab, Trastuzumab, and Docetaxel in HER2-Positive Metastatic Breast Cancer | New England Journal of Medicine. Accessed May 22, 2024. https://​www-nejm-org.​ezproxy.​uvm.​edu/​doi/​full/​https://​doi.​org/​10.​1056/​NEJMoa1413513
89.
go back to reference Swain SM, Ewer MS, Viale G, et al. Pertuzumab, trastuzumab, and standard anthracycline- and taxane-based chemotherapy for the neoadjuvant treatment of patients with HER2-positive localized breast cancer (BERENICE): a phase II, open-label, multicenter, multinational cardiac safety study. Ann Oncol. 2018;29(3):646–53. https://doi.org/10.1093/annonc/mdx773.CrossRefPubMed Swain SM, Ewer MS, Viale G, et al. Pertuzumab, trastuzumab, and standard anthracycline- and taxane-based chemotherapy for the neoadjuvant treatment of patients with HER2-positive localized breast cancer (BERENICE): a phase II, open-label, multicenter, multinational cardiac safety study. Ann Oncol. 2018;29(3):646–53. https://​doi.​org/​10.​1093/​annonc/​mdx773.CrossRefPubMed
92.
94.
go back to reference Krop IE, Im SA, Barrios C, et al. Trastuzumab Emtansine Plus Pertuzumab Versus Taxane Plus Trastuzumab Plus Pertuzumab After Anthracycline for High-Risk Human Epidermal Growth Factor Receptor 2–Positive Early Breast Cancer: The Phase III KAITLIN Study. JCO. 2022;40(5):438–48. https://doi.org/10.1200/JCO.21.00896.CrossRef Krop IE, Im SA, Barrios C, et al. Trastuzumab Emtansine Plus Pertuzumab Versus Taxane Plus Trastuzumab Plus Pertuzumab After Anthracycline for High-Risk Human Epidermal Growth Factor Receptor 2–Positive Early Breast Cancer: The Phase III KAITLIN Study. JCO. 2022;40(5):438–48. https://​doi.​org/​10.​1200/​JCO.​21.​00896.CrossRef
97.
go back to reference First-in-Human, Phase I Dose-Escalation and Dose-Expansion Study of Trophoblast Cell-Surface Antigen 2–Directed Antibody-Drug Conjugate Datopotamab Deruxtecan in Non–Small-Cell Lung Cancer: TROPION-PanTumor01. Journal of Clinical Oncology. Accessed April 24, 2024. https://ascopubs.org/doi/https://doi.org/10.1200/JCO.23.00059 First-in-Human, Phase I Dose-Escalation and Dose-Expansion Study of Trophoblast Cell-Surface Antigen 2–Directed Antibody-Drug Conjugate Datopotamab Deruxtecan in Non–Small-Cell Lung Cancer: TROPION-PanTumor01. Journal of Clinical Oncology. Accessed April 24, 2024. https://​ascopubs.​org/​doi/​https://​doi.​org/​10.​1200/​JCO.​23.​00059
98.
99.
go back to reference Geyer CE, Chan S, Jagiello-Gruszfeld A, Kaufman B, Davidson N, Rubin SD. Lapatinib plus Capecitabine for HER2-Positive Advanced Breast Cancer. The New England Journal of Medicine. Published online 2006. Geyer CE, Chan S, Jagiello-Gruszfeld A, Kaufman B, Davidson N, Rubin SD. Lapatinib plus Capecitabine for HER2-Positive Advanced Breast Cancer. The New England Journal of Medicine. Published online 2006.
Metadata
Title
Cardio-Oncology and Breast Cancer Therapies
Authors
Rohit Singh
Krina Patel
Haze Xu
Aderonke Adeniyi
Jenica N. Upshaw
Peter Van Buren
Peter A. Kaufman
Kim Dittus
Kara K. Landry
Publication date
21-04-2025
Publisher
Springer US
Published in
Current Treatment Options in Oncology / Issue 5/2025
Print ISSN: 1527-2729
Electronic ISSN: 1534-6277
DOI
https://doi.org/10.1007/s11864-025-01311-x

Women’s health knowledge hub

Elevate your patient care with our comprehensive, evidence-based medical education on women's health. Designed to help you provide exceptional care for your female patients at every stage of life, we provide expert insights into topics such as reproductive health, menopause, breast cancer and sex-specific health risks and precision medicine.

Read more

Incorporating comprehensive genomic profiling into the standard-of-care for NSCLC and thyroid cancer

In this interactive webinar, experts Dr. Subbiah, Dr. Drilon, and Dr. Williams discuss best pathological practices within NSCLC and thyroid cancer, as well as how genomic testing can improve outcomes in clinical practice, using patient case studies as illustrations.

This content is intended only for US-based healthcare providers.

Supported by:
  • Illumina, Inc., and Eli Lilly and Company
Dr. Vivek Subbiah
Dr. Alexander Drilon
Dr. Michelle Williams
Developed by: Springer Healthcare
Watch now
Video

Elevate your expertise in aplastic anemia (Link opens in a new window)

Transform the way you care for your patients with aplastic anemia with our 3-module series using real-world case studies and expert insights. Discover why early diagnosis matters, explore the benefits and risks of current treatments, and develop tailored approaches for complex cases. 

Supported by:
  • Pfizer
Developed by: Springer Healthcare IME
Learn more