Late anthracycline-related cardiotoxicity in low-risk breast cancer patients

Anthracyclines improve survival in breast cancer , but can cause cardiotoxicity. Determining cardiotoxicity prevalence is difficult; definitions vary, presentation may be delayed, and risk varies by chemotherapy regime and dose, and with cardiovascular comorbidities. We sought to assess late anthracycline cardiotoxicity in low-risk breast cancer survivors receiving standard anthracyclines, using multimodality imaging. Subjects recruited to a previous study of early anthracycline cardiotoxicity and were free from preexisting cardiovascular risk factors or disease, treated for early stage breast cancer, and all patients underwent standard CMR imaging before chemotherapy were invited to participate. Investigations at follow-up included repeat cardiac MR, echocardiography as well as blood biomarkers. Female healthy volunteers (HV) of similar age were recruited for comparison (n = 34). Using multimodality technologies in a low-risk population followed for 6 years, standard anthracycline chemotherapy caused no clinically significant cardiotoxic effects (no cardiovascular deaths, heartfailure events, or decreases in function sufficient to meet cancer therapy-related cardiac dysfunction criteria). There were small, dose-related changes in cardiac function when compared with HV, but these modest cardiac changes compare with 15% cancer recurrence, including 6% who died. This is an imbalance; in low-risk patients, the risk of late cardiotoxicityseems to be small compared with tumor recurrence and progression risk.