Case Study: Evaluation of Anticancer Treatment and Cardiovascular Safety in a Breast Cancer Patient with Pre-existing Cardiovascular Conditions - Report - MDSpire
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Case Study: Evaluation of Anticancer Treatment and Cardiovascular Safety in a Breast Cancer Patient with Pre-existing Cardiovascular Conditions
Balancing Breast Cancer Therapy and Cardiovascular Safety in a High-Risk Patient
Overview
This case study highlights successful management of a HER2-positive breast cancer patient with multiple cardiovascular comorbidities using a low-cardiotoxicity regimen and individualized perioperative antithrombotic therapy. Continuous cardiac monitoring and multidisciplinary team involvement ensured no cardiovascular complications during treatment.
Background
Cancer therapy-related cardiovascular toxicity (CTR-CVT) is a significant concern, especially in elderly breast cancer patients with pre-existing cardiovascular diseases such as hypertension, diabetes mellitus, and coronary heart disease. The 2022 ESC Guidelines emphasize comprehensive cardiovascular risk stratification and dynamic monitoring to balance oncologic efficacy and cardiovascular safety. Multidisciplinary teams play a crucial role in selecting appropriate anticancer regimens, managing perioperative antithrombotic therapy, and monitoring cardiac function to minimize cardiovascular risks during cancer treatment.
Data Highlights
Parameter
Pre-treatment
Post-treatment
Triglycerides (mmol/L)
3.27
Not reported
Blood Glucose (mmol/L)
13.32
Not reported
Left Ventricular Ejection Fraction (LVEF, %)
69
59
Cardiac Biomarkers (BNP, Troponin)
Normal
Normal
Axillary Lymph Nodes Positive
Metastasis present
1/16 nodes positive post-surgery
Radiotherapy Heart Dose
Not applicable
Mean heart dose <8 Gy
Key Findings
The patient had multiple cardiovascular risk factors including hypertension, diabetes mellitus, and coronary heart disease post-PCI.
A low-cardiotoxicity PTD regimen (pertuzumab, trastuzumab, docetaxel) was selected to minimize cardiac risk.
Perioperative antithrombotic management included withholding aspirin, discontinuing clopidogrel 5 days pre-surgery, and LMWH bridging based on low bleeding risk scores.
Regular cardiac monitoring with biomarkers, ECG, and echocardiography detected no cardiovascular complications throughout treatment.
Postoperative radiotherapy was delivered with strict heart dose constraints to reduce cardiac exposure.
Multidisciplinary team coordination enabled individualized treatment balancing oncologic efficacy and cardiovascular safety.
Clinical Implications
In breast cancer patients with pre-existing cardiovascular disease, selecting anticancer regimens with low cardiotoxicity and implementing individualized perioperative antithrombotic strategies are essential to minimize cardiovascular risks. Continuous cardiac function monitoring allows early detection of subclinical injury, facilitating timely intervention. Multidisciplinary collaboration is critical to optimize both oncologic and cardiovascular outcomes.
Conclusion
Comprehensive baseline cardiovascular assessment, careful regimen selection, rational perioperative antithrombotic management, and ongoing cardiac surveillance can successfully balance effective breast cancer treatment with cardiovascular safety in high-risk patients.
References
2022 ESC Guidelines on Cardio-Oncology -- Risk Stratification and Monitoring
PRECISE-DAPT and HAS-BLED Scores -- Antithrombotic Risk Assessment
