Cardiovascular diseases (CVD) and Cancer (C), the most important causes of mortality worldwide. share many risk factors and common pathophysiological processes such as chronic inflammation and unfavorable cardio-metabolic profile. Progress in oncological treatments improved the survival of oncological patients (Pt) but have increased the likelihood of short- and long-term CV cardiovascular complications. The multidisciplinary collaboration between cardiologist and onco-hematologists is the task of Cardioncology, an emerging new sub-specialization of clinical cardiology that often make available personalized treatment with a favorable outcome also in clinically complex patients. Here we present a case of severe acute heart failure in a woman with advanced breast C (BC).
2021 April: 55-year-old woman with G3 BC, (ER 0%PgR 0%,Ki6770%HER2+) (T4N3M1), (chest wall and liver) on well tolerated treatment with Docetaxel X 6 and continuous double antiHER2 block (Trastuzumab + Pertuzumab) X 4 and steroids as ancillary therapy. After about 6 months of therapy a lower airways infection occurred and acute congestive heart failure (HF) with severe left ventricular systolic dysfunction (LVEF 25%) ensued requiring hospitalization in the ICU, where newly detected type II diabetes was diagnosed. Appropriate HF therapy with insulin and anticoagulant was established and congestive clinical state resolved. On outpatient basis B-Blocker and anti-RAAS therapy was titrated switching to empagliflozin. About 7 months after discharge, we registered the full recovery up to a normalization of systolic function (LVEF 55%) and the disappearance of the intraventricular thrombus. For progression of C, pt underwent chemotherapy with Capecitabine at metronomic and in October 2022 after cardio-oncological collegial discussion, anti-HER2 therapy resumed. Paz started Trastuzumab-Emtansine, well tolerated with substantial stability of the clinical picture (NYHA I-II) and instrumental and echocardiographic evaluation (LVEF 65%).
This clinical case reaffirms that close collaboration between cardiologist and oncologist is fundamental for the successful management of complex patients and surveillance must also extend during (and after) treatment. It also demonstrates that an early diagnosis and an "evidence-based" cardiological therapy can allow the recovery of the cardio-toxic effect of anti-HER2 drugs and may allow to resume the therapy successfully.