Long-term Cardiac Health and Dose Dense
At the time of diagnosis of breast cancer, we are all focused on identifying the best possible treatment to maximize our chances of long and healthy lives. Even at that difficult time, however, we wonder about possible medium and long-term side effects that might trouble us in the future. Among the more serious of those concerns is cardiac damage either from certain chemotherapy agents and/or from radiation therapy to the left breast.
This editorial by Ewer and Ewer in a recent issues of the Journal of Clinical Oncology addresses the possible later risks from Dose Dense (every 2 weeks) CA. The bottom line is reassuring, but here is a quote and then a link to read more:
Long-Term Cardiac Safety of Dose-Dense Anthracycline Therapy Cannot Be Predicted From Early Ejection Fraction Data
Michael S. Ewer, Department of Cardiology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
Steven M. Ewer, Division of Cardiovascular Medicine, The University of Wisconsin School of Medicine and Public Health, Madison, WI
See accompanying article on page 6117
The report by Morris et al1 in this issue of the Journal of Clinical Oncology provides an interesting opportunity to revisitsomeaspects of anthracycline cardiotoxicity. Notwithstanding more than three decades of research, cancer treatment-related cardiotoxicity remains a matter of considerable interest and an area of research that has expanded tica;">dramatically in the years after the introduction of targeted therapy. No group of cardiotoxic anticancer agents has been studied more extensively or over a greater period of time than the anthracyclines.
The Morris et al1 report, while intriguing, raises a number of questions and spotlights some uncertainties that can best be placed in perspective by a brief overview of this frequently discussed yet often >misunderstood entity.
So where does this report leave us? The oncologic outcome of dose-dense regimens with regard to time to progression and overall survival has been previously reported. Although there was no direct comparison with standard regimens, we now have the additional information that early cardiotoxicity with dose-dense regimens is not prohibitive. This early data is also important for the many women who hope to benefit from subsequent trastuzumab; it does not appear that dose-dense regimens significantly interfere with candidacy for further adjuvant treatment. However, any assumption that these regimens will not cause future problems is perhaps premature. This is especially relevant in the adjuvant setting, where we expect that increasing numbers of patients will enjoy long-term survival. For the present, dose dense regimens should be selected on the basis of their oncologic advantage; cardiotoxicity, while not an insurmountable problem in the short-term, remains a potential concern for the future well-being of these patients. Cardiologists and oncologists should continue to< work together to find ways of identifying high-risk patients .