Heart Function Checks After Breast Cancer Chemotherapy

What is cancer drug-related myocardial damage?

Our clinic (director) specializes in cardiovascular medicine, not breast cancer. The reason why we include articles related to breast cancer is that it has recently become clear that cancer itself and cancer treatment drugs are associated with cardiovascular problems. Cardiovascular problems such as high blood pressure, arrhythmia, thrombosis, and heart failure. In particular, anthracycline anticancer drugs and molecular target drugs used for breast cancer carry the risk of deteriorating cardiac function. This is called Cancer Therapy-Related Cardiac Dysfunction (CTRCD). The main drugs that cause CTRCD are:

Anthracycline anticancer drug:This drug can cause long-term damage to the heart muscle, putting you at risk for heart failure. The total amount used is relevant, and the breast doctor determines the volume from professional detection.

Molecular target therapy: Drugs that specifically target HER2 (e.g. trastuzumab, pertuzumab) may affect cardiac function. These drugs can cause cardiotoxicity independent of dose and treatment duration.

Expected role of heart failure clinic

Although much was not well understood about cancer drug-related myocardial damage (CTRCD), the field of tumor cardiology is rapidly developing with the advent of molecular target therapeutics. Knowledge related to CTRCD is also being updated rapidly. It was previously thought that heart failure caused by anthracycline anticancer drugs was irreversible, but it has become clear that drug treatment can sometimes improve heart function (1). In addition, it is becoming known that myocardial damage does not occur suddenly, but rather occurs gradually, and in the early stages, symptoms of heart failure are preceded by an increase in the blood sample troponin and a decrease in the GLS value in an echocardiogram, and eventually the heart's pumping function declines, leading to symptoms such as shortness of breath and fluid retention (edema) (2). On the other hand, with molecular targeted drugs, it was initially thought that even if a decline in cardiac function occurred, it would only temporarily recover. However, new data has recently emerged showing that when molecular targeted drugs are used, there remains a risk of heart failure even after some time has passed (3).

There are three possible roles that a heart failure clinic can play:

1. Periodic cardiac function evaluation
2. Treatment for heart failure and management of heart failure risks such as hypertension
3. Timely introduction of heart failure drugs

Periodic cardiac function evaluations are performed every 1 to 3 months during chemotherapy, and every 6 months to 1 year depending on the condition. We also actively treat high blood pressure and other risks of heart failure. We detect heart failure symptoms early and evaluate the suitability of heart failure treatment drugs.

Particularly after breast cancer chemotherapy is completed, periodic echocardiography is often not performed routinely, so it is important to regularly evaluate cardiovascular risks and reduce the risk of heart failure.

References

(1) Cardinale, D., Colombo, A., Bacchiani, G., Tedeschi, I., Meroni, C. A., Veglia, F., Civelli, M., Lamantia, G., Colombo, N., Curigliano, G., Fiorentini, C., & Cipolla, C. M. (2015). Early detection of anthracycline cardiotoxicity and improvement with heart failure therapy. Circulation, 131(22), 1981–1988.

(2)Cardinale, D., Iacopo, F., & Cipolla, C. M. (2020). Cardiotoxicity of Anthracyclines. Frontiers in Cardiovascular Medicine, 7, 26.

(3)Banke Ann, Fosbøl Emil L., Ewertz Marianne, Videbæk Lars, Dahl Jordi S., Poulsen Mikael Kjær, Cold Søren, Jensen Maj-Britt, Gislason Gunnar H., Schou Morten, & Møller Jacob E. (2019). Long-Term Risk of Heart Failure in Breast Cancer Patients After Adjuvant Chemotherapy With or Without Trastuzumab. JACC: Heart Failure, 7(3), 217–224.