Thursday, August 11, 2011

Breast Cancer News (8/11): Cardiotoxicity

Breast cancer treatment side effects are in the news again. Earlier this week, we shared the recent research on nausea and thromboembolic events. Today we'll review the latest studies on cardiotoxicity, the heart damage caused by some breast cancer treatments. As always, the news stories and studies discussed below may be found on the treatment pages of the website.

Herceptin-induced cardiotoxicity in elderly patients

The big story was a small study from Spain in the Annals of Oncology which assessed the cardiotoxicity of Herceptin (trastuzumab) in women older than 70. Twelve of the 45 women in the study developed Herceptin-related cardiotoxicity. According to Medical News Today, "Earlier clinical trials in younger, healthier women revealed a slightly lesser rate."

Cardiotoxicity was more prevalent in women with cardiovascular risk factors. It developed in 33% of the women with cardiac disease and 33.3% of the women with diabetes. By contrast, only 9.1% of those without cardiac disease and 6.1% of those without diabetes developed heart damage.

The cardiotoxicity induced by Herceptin was reversible in most. According to US News and World Report, "When the women with heart problems stopped taking Herceptin, all but one recovered fully and five were able to re-start treatment with the drug."

In conclusion, Dr. Cesar Serrano, who conducted the study, was quoted in Medical News Today, "We think that it is reasonable to refer elderly breast cancer patients to a cardiologist if one or more cardiovascular risk factors are present before or during treatment with trastuzumab. Moreover, a closer surveillance of early symptoms and cardiac function is highly recommended."

Exercise and Adriamycin-related cardiotoxicity

Can aerobic exercise prevent or reduce the heart damage associated with
Adriamycin (doxorubicin)? Researchers from the NASA Johnson Space Center asked that very question in a review in Circulation, a journal of the American Heart Association. To lay the preliminary groundwork, the authors reviewed the molecular mechanisms of chemotherapy-induced cardiotoxicity and the effects of exercise on heart tissue. Their early findings "have implications for future research regarding the application and effectiveness of exercise and doxorubicin treatment in humans."

Sutent and the risk of congestive heart failure

Sutent (sunitinib) is approved for renal cell carcinoma and gastrointestinal stromal tumors, and is in clinical trials for breast cancer. A Journal of Clinical Oncology review of phase II and phase III trials found Sutent to be associated with an increased risk of congestive heart failure in cancer patients.

A story and video from provides more detail. The review included 16 studies of renal cell carcinoma and other cancers, involving almost 7,000 patients. Patients treated with Sutent had about a 3-fold higher relative risk of developing high-grade congestive heart failure. The authors concluded that "clinicians need to be aware of the risk of CHF with sunitinib treatment to provide early intervention and balance therapeutic benefit with this potentially life-threatening adverse effect."

Tomorrow, we'll review the latest breast cancer research on another treatment side effect - insomnia. Please stay tuned.

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