Emerging Treatment Strategies Aim to Balance Cardiac Safety, Effective Breast Cancer Care: Eric H. Yang, MD

Patients who develop cardiac issues during breast cancer treatment should be managed through close collaboration between cardiology and oncology teams, using a multidisciplinary approach and heart-protective medications to continue therapy safely, according to Eric H. Yang, MD, in an interview at last month's San Antonio Breast Cancer Symposium. He also highlights emerging treatment strategies that aim to optimize cardioprotection while maintaining effective cancer care.

Watch parts 1 and 2 to learn which breast cancer therapies carry the greatest risk for cardiotoxicity and how cardiovascular and breast cancer risks intersect.

This transcript has been lightly edited for clarity; captions were auto-generated.

Transcript

How should patients who develop cardiac issues mid-treatment be managed without compromising care?

This is actually kind of referring to what I like to call permissive cardiotoxicity, because we still don't quite really know who is at risk, but if it happens where your heart function declines with certain kinds of chemotherapy or targeted therapies, what do you do? I think this is where integration of a cardio-oncology or cardiovascular component of the care is really critical because we know that if, also, you stop cancer therapy prematurely, you may not do as well.

So, it's very important that you have someone who is engaged and invested in these patients from a heart standpoint to try to get them on medications to treat heart dysfunction, of which we have many options, and also to have a multidisciplinary roadmap to be able to try to continue therapy, even if there is ongoing toxicity, to the best of their ability, for as much as the patient and the cancer teams can tolerate it. I think the very rewarding thing is that you're able to get patients through not just 1 journey, but 2 journeys, going through heart disease treatment as well as cancer treatments. I frankly think there's very few things in cardiology that are more rewarding than being able to get them through 2 very, very serious issues, but that requires a lot of close coordination of care and multidisciplinary collaboration between cardiology and cancer.

What advances or innovations do you expect will improve cardioprotection for patients with breast cancer in the future?

In the cardio-oncology field, they are, I guess you could say, a bit on the simple side, but honestly, I think they have the potential to be very impactful. There's a trial that is currently looking at this concept of permissive cardiotoxicity with HER2 breast cancer, that if your ejection fraction drops and you don't have severe or significant heart failure symptoms, you're randomized to either continuing HER2 therapy with medical therapy or just doing the traditional arm of holding it until it gets better. We're going to see which one is a better arm and whether it is safe to continue ongoing HER2 treatments if there is no severe cardiac compromise.

There's also, I know, from Canada an ongoing trial looking at descaling HER2 treatments of just, by itself, monotherapy. The incidence of heart dysfunction is very, very low if anthracyclines are not used. So, there's an opportunity to look at resource utilization with this trial. Both of these studies are coming out of Canada.

We are also in the midst of looking at this trial of abatacept in immune checkpoint inhibitor-related myocarditis, which is being done in the United States. It's also looking at the effects of this drug in reducing severe cardiovascular complications, such as heart failure, death, and severe arrhythmias, for those who do contract this rare but serious complication.