Abstract：
Breast cancer is one of the most common types of cancer, representing 15 % of all new cancer cases in the United States. Approximately 12.4 % of all women will be diagnosed with breast cancer during their lifetime. In the past decades, a decrease in cancer-related mortality is evident as a result of early screening and improved therapeutic options. Nonetheless, breast cancer survivors face long-term treatment side effects, with cardiotoxicity being the most significant one, which lead to increased morbidity and mortality. Breast cancer patients are particularly susceptible to cancer therapeutics-related cardiac dysfunction (CTRCD) as treatment regimens include cardiotoxic drugs, primarily anthracyclines and anti-human epidermal growth factor receptor 2 (anti-HER2) agents (recombinant humanized monoclonal antibodies directed against HER2 such as trastuzumab and pertuzumab). Cardiotoxicity is the most common dose-limiting toxicity associated with trastuzumab. Discontinuation of trastuzumab however, can lead to worse cancer outcomes. There have been case reports, registry-based, retrospective cohort-based and mechanistic studies suggesting the cardioprotective potential of SGLT2i in CTRCD. It is not known whether SGLT2i can prevent the development of incident HF or reduce the risk of HF in patients receiving trastuzumab with or without other concurrent anti-HER2 agent or sequential anthracycline for treatment of HER2 positive breast cancer. Based on these, there is now a call for randomized controlled trials to be performed in this patient cohort to advise guideline-directed therapy for CTRCD, which will in turn also provide detailed safety information and improve cancer and cardiovascular outcomes.
摘要：
乳腺癌是最常见的癌症之一，占美国所有新癌症病例的15%。大约12.4%的女性将在其一生中被诊断出患有乳腺癌。在过去的几十年里，由于早期筛查和治疗方案的改进,癌症相关死亡率明显下降.尽管如此，乳腺癌幸存者面临长期治疗副作用，心脏毒性是最重要的，导致发病率和死亡率增加。乳腺癌患者特别容易患癌症治疗相关的心脏功能障碍（CTRCD），因为治疗方案包括心脏毒性药物，主要是蒽环类和抗人表皮生长因子受体2（抗HER2）药物（针对HER2的重组人源化单克隆抗体，例如曲妥珠单抗和帕妥珠单抗）。心脏毒性是与曲妥珠单抗相关的最常见的剂量限制性毒性。然而，停止曲妥珠单抗，会导致更坏的癌症结果。有病例报告,基于注册表，回顾性队列和机制研究表明SGLT2i在CTRCD中具有心脏保护潜力.尚不清楚SGLT2i是否可以预防患有或不患有其他并发抗HER2药物或序贯蒽环类药物治疗HER2阳性乳腺癌的曲妥珠单抗的患者发生HF或降低HF的风险。基于这些,现在呼吁在该患者队列中进行随机对照试验，以建议CTRCD的指南指导治疗，这反过来也将提供详细的安全信息，并改善癌症和心血管结局。
