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      Heart failure prevention and monitoring strategies in HER2-positive breast cancer: a narrative review

      review-article
      Author(s): 1 , 2 ,
      Publication date (Electronic):
      Journal: Breast Cancer Research and Treatment
      Publisher: Springer US
      Keywords: HER2-positive, Breast cancer, Cardiotoxicity, Trastuzumab

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          Abstract

          Purpose

          Cardiotoxicity from anti-human epidermal growth factor receptor 2 (HER2) therapy carries a short- and long-term risk of incident heart failure and increased cardiovascular mortality in patients with breast cancer. Interruptions in anti-HER2 therapy due to cardiotoxicity can lead to suboptimal cancer treatment. The purpose of this narrative review is to outline opportunities to optimize cardiovascular care in patients with HER2-positive breast cancer to prevent interruptions in therapy.

          Methods

          This case-based review presents the current literature on evidence-based strategies for personalized cardiotoxicity risk assessment, risk mitigation interventions, cardiac function surveillance tools, and management of asymptomatic left ventricular dysfunction in breast cancer patients receiving anti-HER2 therapy.

          Results

          Pretreatment cardiac risk assessment incorporates both treatment-related risk factors and patient-related risk factors for the development of cardiac dysfunction. Prevention and monitoring strategies while on treatment utilize risk factor modification, imaging and biomarker surveillance. Management of asymptomatic left ventricular dysfunction due to anti-HER2 therapy is evolving. Permissive cardiotoxicity in asymptomatic patients while starting cardioprotective therapies requires close collaboration between oncology and cardiology, and referral to cardio-oncology if available.

          Conclusions

          Patient-centered, multimodal strategies to prevent, detect, and manage cardiotoxicity from anti-HER2 therapy are necessary to improve outcomes in patients with HER2-positive breast cancer.

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          Most cited references61

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          Cancer statistics, 2020

          Rebecca Siegel, Kimberly D Miller, Ahmedin Jemal (2020)
          Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States and compiles the most recent data on population-based cancer occurrence. Incidence data (through 2016) were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data (through 2017) were collected by the National Center for Health Statistics. In 2020, 1,806,590 new cancer cases and 606,520 cancer deaths are projected to occur in the United States. The cancer death rate rose until 1991, then fell continuously through 2017, resulting in an overall decline of 29% that translates into an estimated 2.9 million fewer cancer deaths than would have occurred if peak rates had persisted. This progress is driven by long-term declines in death rates for the 4 leading cancers (lung, colorectal, breast, prostate); however, over the past decade (2008-2017), reductions slowed for female breast and colorectal cancers, and halted for prostate cancer. In contrast, declines accelerated for lung cancer, from 3% annually during 2008 through 2013 to 5% during 2013 through 2017 in men and from 2% to almost 4% in women, spurring the largest ever single-year drop in overall cancer mortality of 2.2% from 2016 to 2017. Yet lung cancer still caused more deaths in 2017 than breast, prostate, colorectal, and brain cancers combined. Recent mortality declines were also dramatic for melanoma of the skin in the wake of US Food and Drug Administration approval of new therapies for metastatic disease, escalating to 7% annually during 2013 through 2017 from 1% during 2006 through 2010 in men and women aged 50 to 64 years and from 2% to 3% in those aged 20 to 49 years; annual declines of 5% to 6% in individuals aged 65 years and older are particularly striking because rates in this age group were increasing prior to 2013. It is also notable that long-term rapid increases in liver cancer mortality have attenuated in women and stabilized in men. In summary, slowing momentum for some cancers amenable to early detection is juxtaposed with notable gains for other common cancers.
          Article 0 comments Cited 8839 times – based on 0 reviews     Review now
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            Heart Disease and Stroke Statistics—2019 Update: A Report From the American Heart Association

            Emelia Benjamin, Paul Muntner, Alvaro Alonso … (2019)
            Circulation, 139(10)
            Article 0 comments Cited 2298 times – based on 0 reviews     Review now
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              Cancer treatment and survivorship statistics, 2019

              Kimberly D Miller, Leticia Nogueira, Angela Mariotto … (2019)
              The number of cancer survivors continues to increase in the United States because of the growth and aging of the population as well as advances in early detection and treatment. To assist the public health community in better serving these individuals, the American Cancer Society and the National Cancer Institute collaborate every 3 years to estimate cancer prevalence in the United States using incidence and survival data from the Surveillance, Epidemiology, and End Results cancer registries; vital statistics from the Centers for Disease Control and Prevention's National Center for Health Statistics; and population projections from the US Census Bureau. Current treatment patterns based on information in the National Cancer Data Base are presented for the most prevalent cancer types. Cancer-related and treatment-related short-term, long-term, and late health effects are also briefly described. More than 16.9 million Americans (8.1 million males and 8.8 million females) with a history of cancer were alive on January 1, 2019; this number is projected to reach more than 22.1 million by January 1, 2030 based on the growth and aging of the population alone. The 3 most prevalent cancers in 2019 are prostate (3,650,030), colon and rectum (776,120), and melanoma of the skin (684,470) among males, and breast (3,861,520), uterine corpus (807,860), and colon and rectum (768,650) among females. More than one-half (56%) of survivors were diagnosed within the past 10 years, and almost two-thirds (64%) are aged 65 years or older. People with a history of cancer have unique medical and psychosocial needs that require proactive assessment and management by follow-up care providers. Although there are growing numbers of tools that can assist patients, caregivers, and clinicians in navigating the various phases of cancer survivorship, further evidence-based resources are needed to optimize care.
              Article 0 comments Cited 1612 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Nausheen Akhter:
                ORCID: http://orcid.org/0000-0001-9423-8578
                n-akhter@northwestern.edu
                Journal
                Journal ID (nlm-ta): Breast Cancer Res Treat
                Journal ID (iso-abbrev): Breast Cancer Res Treat
                Title: Breast Cancer Research and Treatment
                Publisher: Springer US (New York )
                ISSN (Print): 0167-6806
                ISSN (Electronic): 1573-7217
                Publication date (Electronic): 22 January 2021
                Pages: 1-9
                Affiliations
                [1 ]GRID grid.19006.3e, ISNI 0000 0000 9632 6718, Division of Cardiology, , David Geffen School of Medicine At UCLA, ; Los Angeles, CA USA
                [2 ]GRID grid.16753.36, ISNI 0000 0001 2299 3507, Division of Cardiology, , Northwestern University Feinberg School of Medicine, ; 675 N St. Clair St, Suite 19-100, Chicago, IL 60611 USA
                Author information
                http://orcid.org/0000-0001-9423-8578
                Article
                Publisher ID: 6096
                DOI: 10.1007/s10549-021-06096-9
                PMC ID: 7820093
                PubMed ID: 33481134
                SO-VID: c98875c9-6be2-4fdf-b354-cc1a52a78017
                Copyright © © The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature 2021
                License:

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                Date received : 7 December 2020
                Date accepted : 5 January 2021
                Categories
                Subject: Review

                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: her2-positive,breast cancer,cardiotoxicity,trastuzumab
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: her2-positive, breast cancer, cardiotoxicity, trastuzumab

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