Protecting the quality of life of patients with breast cancer means thinking about the “after illness” right away. From a strictly medical point of view this translates, for example, into protecting them from the risks associated with therapies. And one of the main ones relates to cardiotoxicity. In fact, more and more often oncologists are (or should be) supported by cardiologists, and there are guidelines drawn up by the Italian Association of Oncology dedicated precisely to the prevention of cardiovascular risks.
Breast cancer, reduce heart risks with cardio fitness
by GIULIA TONIUTTI
14 December 2018
Just this month, the Journal of Clinical Oncology published the results of a study that compared the risk of heart attack, stroke, arrhythmias and venous thromboembolism of more than 13,600 women treated for breast cancer with that of 68,000 women who have never had the disease. Result: The greatest risk of cardiovascular events was observed for women treated with both anthracyclines and trastuzumab. The chances of cardiomyopathies are also high in those who have received radiotherapy and aromatase inhibitor drugs.
I study
It is in this scenario that the Italian SAFE study (already published on JAMA Oncology), whose latest data have just been presented to the European Society of Radiation Oncology – Estro 2022, in Copenhagen. To date, the results support the use of the most popular drugs for cardiovascular disease – beta blockers and ACE inhibitors – in patients undergoing these treatments. The trial is conducted by the Oncological Radiotherapy team of the Careggi University Hospital in Florence, supported by the Oncological Radiotherapy Foundation (FRO, which has been promoting research and assistance for people treated with radiotherapy for over 30 years). “Ischemic events, arrhythmias, pericardial effusion, reduced contractile function and cardiomyopathies are some of the most common short and long-term risks that can occur in the life of people who have faced chemo and radiotherapy”, explains Lorenzo Livi, Professor of Oncological Radiotherapy of the University of Florence and FRO Volunteer, who recalls how anthracyclines are used in about one fifth of women treated for breast cancer.
Heart and Alzheimer’s: higher risks after breast cancer
by MARIA TERESA BRADASCIO
17 December 2019
The investigated drugs are already partially used in oncology in people considered at risk of cardiovascular disease. However, there are still many open questions. “For the most part, the studies conducted so far on the use of these drugs in the cardioprotection of women with breast cancer have enrolled small numbers of patients, or have been closed prematurely,” explains Livi: “Our study instead considered a high number of patients: about 70 per trial arm, for a total of 274. The first patients involved have been followed for 5 years now “.
Protect the heart from radiation therapy
Furthermore, the new method used is able to highlight the micro-damage at the subclinical level, which cannot be detected with normal techniques and which has not yet shown any sign of itself, explains Livi. The study will be completed in June and the definitive results will be available within a few months. For now, the data shows that there is an advantage in using antihypertensive and cardioprotective drugs. The new analysis shows, in particular, the protection against damage from radiotherapy: “We observed that the patients irradiated in the left side, that of the heart, and treated with these drugs did not have greater damage than those who were irradiated in the right side. In our field – concludes Livi – reducing the radiations administered through hypofractionation techniques and managing the undesirable effects of chemotherapy represent joint strategies, which can have a tangible impact in reducing the risk of cardiac toxicity “.