# Cardiotoxicity in Elderly Breast Cancer Patients

## TL;DR

This paper reviews the high risk of heart damage in elderly breast cancer patients and highlights the need for better management strategies and clinical trials.

## Contribution

The paper emphasizes the unique challenges in managing cardiotoxicity in elderly breast cancer patients and calls for prospective trials to improve care.

## Key findings

- Elderly breast cancer patients face significant cardiotoxicity risks due to comorbidities and frailty.
- Current guidelines recommend preventive and educational strategies to optimize outcomes in this vulnerable group.
- Prospective trials like CARTIER and CARDIOCARE are needed to better manage cardiotoxicity in elderly patients.

## Abstract

This review focuses on cardiotoxicity in elderly breast cancer patients. The factors that contribute to their high cardiotoxicity risk and the challenges in the management due to comorbidities and frailty are presented. It also includes specific recommendations from the oncology and cardio-oncology guidelines, preventive and educational strategies foroptimizing outcomes in this vulnerable population. Given the increasingnumber of elderly breast cancer patients and survivors and the limited available data, there is a critical need for prospective trials like the ongoing CARTIER and CARDIOCARE, that will facilitate the managementof this special population.

Cardiotoxicity is a leading cause of mortality in the growing populations of elderly breast cancer (BC) patients. Breast cancer treatment in the elderly is highly challenging due to its heterogeneous nature and the lack of specific evidence, as this population is usually underrepresented in randomized clinical trials. Decision making requires a comprehensive approach, considering the type and stage of BC, the patient’s overall health status, life expectancy, geriatric and frailty assessment, the risk of cancer recurrence, comorbidities, cardiotoxicity risk, and the patient’s preferences. The cardiotoxic effects of BC treatments cover the whole spectrum of cardiovascular diseases: heart failure, hypertension, arrhythmias, and myocardial ischemia. Cardiotoxicity risk in these patients is defined by several factors: anticancer therapies, polypharmacy, established cardiovascular disease, comorbidities, frailty, cellular senescence, hormonal changes, and genetic predisposition. Preventive oncological and cardio-oncological strategies, as well as patients’ education, are critical for improved outcomes. Prospective clinical trials in this population are urgently needed.