14-05-2025
Fast Five Quiz: Metastatic Breast Cancer Treatment Issues
Breast cancer care has made remarkable strides in recent years, with advancements in imaging, targeted therapies, minimally invasive surgical techniques, and personalized medicine leading to improved survival rates. Despite these innovations, the management of metastatic and advanced breast cancer remains complex, with treatment-related complications posing significant challenges. From cardiotoxicity to issues such as fatigue, neuropathy, and bone loss, understanding these potential effects is essential for optimizing patient care. As survival rates improve, addressing these challenges becomes even more critical in ensuring long-term well-being.
How well do you understand the treatment complications of metastatic and advanced breast cancer? Take this quick quiz and test your knowledge.
Human epidermal growth factor receptor-2 (HER2) targeted therapies are associated with a higher risk for treatment-related cardiovascular toxicity, particularly in causing cancer therapy–related cardiac dysfunction during and after treatment. Anthracycline-based and HER2-targeted therapies pose significant risks of cardiovascular toxicity, including heart failure, making them a major concern for long-term breast cancer survivors.
Although antibody-drug conjugates and immune checkpoint inhibitors are being rapidly developed and used alongside traditional chemotherapy, their cardiovascular toxicity risks remain less well understood and appear to be lower compared with HER2-targeted treatments. Additionally, sodium glucose cotransporter-2 inhibitors have shown promise in cardioprotection rather than contributing to cardiovascular toxicity.
Learn more about HER2-targeted therapies.
A key complication associated with whole-brain radiotherapy is neurocognitive decline. Whole-brain radiotherapy can cause long-term impairments in verbal learning, memory, executive function, and verbal fluency, primarily due to hippocampal dysfunction. Stereotactic radiosurgery can affect verbal learning, memory, fine motor coordination, and executive function.
Meningitis, seizures, and hemorrhage are complications more commonly associated with surgical treatment of brain metastases, not whole-brain radiotherapy.
Learn more about brain metastasis in metastatic breast cancer.
According to a comprehensive analysis, non-Hispanic Black patients with late-stage breast cancer had higher rates of chemotherapy-related complications compared with non-Hispanic White patients. This includes higher rates of cardiomyopathy, diarrhea/enteritis, fatigue, nausea/vomiting, neuropathy, lung disease, pain, dehydration/hypovolemia, rash, and infusion reactions. Non-Hispanic Black patients also had higher rates of cardiovascular toxicities such as acute myocardial infarction and pneumonitis. Non-Hispanic White patients had higher rates of being diagnosed with psychological issues, although non-Hispanic Black patients had higher rates of cognitive decline and dementia.
There were no significant differences in overall immune-related toxicities between non-Hispanic Black and non-Hispanic White patients. These racial disparities in breast cancer treatment-related adverse events might be due to non-Hispanic Black and non-Hispanic White patients receiving different treatments. Non-Hispanic Black patients have a higher probability of receiving adjuvant therapy, whereas non-Hispanic White patients have a higher probability of undergoing curative-intent breast cancer surgery and being prescribed endocrine therapy.
Learn more about breast cancer treatment protocols.
A systematic review and meta-analysis indicated that although various postoperative complications can occur, seroma is the most frequently reported. It involves the accumulation of fluid at the surgical site, which can lead to discomfort, delayed wound healing, and, in some cases, infection. Other complications, such as hematoma, surgical-site infection, and chronic neuropathic postoperative pain, are also recognized but occur less frequently.
Learn more about surgical treatment of breast cancer.
Calcium channel blockers are preferred for managing cancer therapy-related cardiac dysfunction in patients with advanced breast cancer and hypertension, due to their cardiovascular benefits. Calcium channel blockers, particularly in combination with renin-angiotensin system inhibitors, provide superior cardiovascular outcomes compared with beta-blockers and diuretics in hypertensive patients undergoing cardiotoxic chemotherapy. They effectively reduce blood pressure variability and arterial stiffness, contributing to improved cardiovascular health.
Although diuretics are commonly used to manage hypertension and heart failure, they do not provide the same protective cardiovascular benefits as calcium channels blockers or renin-angiotensin system inhibitors in this specific patient population. Although statins might reduce oxidative stress and inflammation, their efficacy in preventing cancer therapy-related cardiac dysfunction remains controversial due to conflicting results from major clinical trials. Beta-blockers are used for heart failure management but are not the preferred antihypertensive agents in patients undergoing cardiotoxic chemotherapy.
Learn more about signs and symptoms of hypertension.
