CONGRESS ABSTRACT

We describe the clinical case of an 82-year-old woman with a history of breast cancer treated with quadrantectomy and subsequent adjuvant chemotherapy three years earlier, which was interrupted early due to an episode of cardiac toxicity manifested by congestive heart failure and a moderate reduction in ejection fraction. The patient was admitted to the cardiology department and subjected to high-dose diuretic therapy with progressive improvement in compensation and recovery of systolic function after approximately one year. After two years the patient showed a lymph node recurrence of the disease. After a collegial discussion of the clinical case between oncologists and cardiologists, considering the need to resume chemotherapy but the patient's cardiac fragility, it was decided to set up a cardio-protective therapy with beta-blocker, ACE-inhibitor and glifozine. The patient is still undergoing chemotherapy and has not shown any clinical or instrumental recurrence of heart failure. The population of cancer survivors is growing due to earlier detection and better treatment options. Unfortunately, the anti-cancer treatment use is limited by unintended cardiotoxicity, which presents as a disease spectrum from asymptomatic systolic dysfunction to clinical heart failure;  acutely,  can also cause arrhythmia and a myocarditis-like syndrome. One of the reasons the old heart is particularly vulnerable to cardiotoxicity by chemotherapy is probably the age-related loss of cardiomyocytes. This subsequently leads to the decrease of myocardial volume, which is correlated to increased CV events. Aging in general is often accompanied by the development of comorbidities, including hypertension, high cholesterol and diabetes mellitus, which directly translate in a higher number of prescribed medications. The fear for cardiotoxicity in elderly patients leads to other issues: under treatment and under representation in clinical trials. Although it has been shown that optimal therapy effectively decreases symptoms and improves quality of life and overall survival, older patients are often treated based on age and the number of comorbidities alone. As a result, they often do not receive guideline-recommended treatment. Therefore, determination of toxicity and development of prevention strategies are essential for optimal cancer treatment and for minimizing toxic side-effects, especially in the most vulnerable patient populations.