Cardiotoxicity of Anthracycline-based Chemotherapy in Breast Cancer Patients: A Case Series

Abstract

In Kazakhstan, breast cancer (BC) remains the leading cause of cancer morbidity and mortality among women. The presented case series aims to summarize cardiovascular events that resulted in anthracycline-based chemotherapy discontinuation or suspension during the ongoing project on studying the cardiotoxicity effects. Case 1. Classic acute cardiotoxicity with asystole. Patient Sh., 46 years old, was admitted with a baseline LVEF of 64% and GLS of 22.4%. After the first dose of doxorubicin 60 mg/m2 and cyclophosphamide 600 mg/m2, the patient experienced two episodes of asystole. She was prescribed Trimetazidine at a dose of 80 mg. Eventually, Sh. completed the courses of anthracycline therapy after a 1-month delay at a cumulative dose of 455 mg/m2. Case 2. Subacute cardiotoxicity with ventricular extrasystole. Patient Zh., aged 47, developed single, paired, and group ventricular extrasystoles after the 2nd course of chemotherapy with doxorubicin 200 mg/m2 (23 days after admission). Carvedilol was prescribed at 25 mg twice daily and Trimetazidine at 80 mg once a day. After 1 month of monitoring, ventricular extrasystoles disappeared. With a month’s delay, the patient completed chemotherapy at a cumulative dose of 400 mg/m2. Case 3. Severe cardiotoxicity due to pre-existing cardiovascular disease with discontinuation of chemotherapy. Patient M., aged 58, was referred to the very highrisk group for developed atrial fibrillation and heart failure with LVEF 51%. M. received Enalapril 5 mg two times per day, Bisoprolol 5 mg, Eplerenone 50 mg, Dapagliflozin 10 mg, and Dabigatran 150 mg twice daily. After 3 months, anthracycline therapy was canceled at a cumulative dose of 260 mg/m2 due to the deterioration of the patient’s condition (LVEF 41%.). Discontinuation or the delay of vitally needed chemotherapy in BC patients deteriorate their prognosis for survival. Patients should be constantly monitored during and after anticancer treatment.