title: Principles of a risk evaluation and mitigation strategy (REMS) for breast cancer patients receiving potentially cardiotoxic adjuvant treatments.
abstract: BACKGROUND
  The number of breast cancer long survivors has increased in the last few years. However, this increase in survival may be affected by the side effects of adjuvant breast cancer therapies. In this context cardiovascular toxicity is considered one of the most clinically important toxicities.
  
  
  METHODS
  In this work we review the published clinical trials of adjuvant treatment on breast cancer, focusing on the trials which accurately mentioned the cardiotoxicity of the adjuvant treatments and those which underwent long term follow up of cardiac function. This article tries to summarize and evaluate the risk of cardiac toxicities associated with different adjuvant treatments for breast cancer (chemotherapy, radiotherapy, endocrine therapy and trastuzumab).
  
  
  CONCLUSIONS
  In our opinion, each individual breast cancer patient should be meticulously evaluated before starting adjuvant treatment in order to basically asses cardiac function and to manage any predisposing risk factor which may increase the probability of treatment induced cardiotoxicity. Rigorous and frequent reassessment of cardiac function along with providing different mitigation strategies that can prevent or decrease the risk of such cardiovascular toxicities are inevitable methods to protect the patient from cardiac events which can mask the survival benefit associated with different adjuvant treatments.
authors.affiliation: a Clinical Oncology Department, Faculty of Medicine , Ain Shams University , Cairo , Egypt.
authors.forename: Sherif Hassanein
authors.initials: SH
authors.lastname: Ahmed
authors.affiliation: a Clinical Oncology Department, Faculty of Medicine , Ain Shams University , Cairo , Egypt.
authors.forename: Diaa-Eldin
authors.initials: DE
authors.lastname: Moussa Sherif
authors.affiliation: b Faculty of Medicine , Ain Shams University , Cairo , Egypt.
authors.forename: Yousef
authors.initials: Y
authors.lastname: Fouad
authors.affiliation: a Clinical Oncology Department, Faculty of Medicine , Ain Shams University , Cairo , Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Kelany
authors.affiliation: a Clinical Oncology Department, Faculty of Medicine , Ain Shams University , Cairo , Egypt.
authors.forename: Omar
authors.initials: O
authors.lastname: Abdel-Rahman
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000628:therapy*; D066126:Cardiotoxicity / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D011832:Radiation Injuries / Q000473:pathology / Q000517:prevention & control; D018570:Risk Assessment / Q000379:methods; D012308:Risk Management / Q000379:methods
chemical_list: D000970:Antineoplastic Agents
keywords: Breast cancer; chemotherapy; hormonal therapy; radiotherapy