Cardiovascular complications of conventional and targeted adjuvant breast cancer therapy.
Adjuvant therapy has improved the survival of women with early breast cancer (BC). Meta-analyses suggest that anthracycline-based regimens reduced the annual BC death rate by ∼40% in women below the age of 50 and 20% in older women. Novel agents designed to modulate abnormal growth factor signaling in and around the BC cell further increase patients' chances of survival. However, both conventional chemotherapeutic agents as well as some of the novel signaling inhibitors can induce important cardiovascular side-effects, potentially attenuating the progress made in recent years. The mechanism of cancer drug-induced cardiovascular complications varies greatly with some compounds inducing irreversible myocardial cell damage, while others lead to temporary cell dysfunction. The challenge of the future will be to prospectively discriminate between irreversible damage which can lead to progressive cardiovascular disease and reversible cardiovascular dysfunctions without further prognostic implications. Since adjuvant therapy for BC is potentially curative, emphasis must be placed on finding treatments combining maximum efficacy with the minimum of long-term side-effects in order to achieve survival with preserved quality of life.
Departments of Oncology, Breast Center, Department of Obstetrics and Gynecology, University of Cologne, Cologne, Germany. Electronic address: nadia.harbeck@uk-koeln.de.
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N
Harbeck
Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, USA.
M S
MS
Ewer
Department of Endocrinology and Molecular and Clinical Oncology, University Federico II, Naples, Italy.
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M
De Laurentiis
Swiss Cardiovascular Center and Cardio-Oncology, Bern University Hospital, Bern, Switzerland.
T M
TM
Suter
Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, USA.
S M
SM
Ewer
D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015415:Biomarkers; D001943:Breast Neoplasms / Q000188:drug therapy*; D002318:Cardiovascular Diseases / Q000150:complications*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects*; D005260:Female; D006321:Heart / Q000187:drug effects; D006801:Humans
D000970:Antineoplastic Agents; D015415:Biomarkers