Cardiology - Original Articles Open access

Cardiovascular toxicity in breast cancer patients – contributors and role of cardioprotective drugs

Authors

Published
28 March 2023
Section
Cardiology - Original Articles
DOI
10.4081/monaldi.2023.2514

Abstract

Breast cancer (BC) patients treated with anthracyclines and/or anti-HER2-targeted therapies (AHT) are highly associated with cardiovascular toxicity (CVT). Our objective was to evaluate the risk of CVT secondary to cancer treatment and the role of cardioprotective-drugs (CPD) in BC patients. We collected a retrospective cohort of females with BC treated with chemotherapy and/or AHT from 2017 to 2019. CVT was defined as LVEF<50% or decline ≥10% during follow-up. As CPD, we considered renin-angiotensin-aldosterone-system inhibitors and beta-blockers. A subgroup analysis of the AHT patients was also performed. A total of 203 women were enrolled. The majority had high or very-high CVT risk score and normal cardiac function at presentation. As for CPD, 35.5% were medicated pre-chemotherapy. All patients were submitted to chemotherapy; AHT were applied to 41.7%. During a 16 months follow-up, 8.5% developed CVT. There was a significant decrease of GLS and LVEF at 12-months (decrease of 1.1% and 2.2%, p<0.001). AHT and combined therapy were significantly associated with CVT. In the AHT sub-group analysis (n=85), 15.7% developed CVT. Patients previously medicated with CPD had a significative lower incidence of CVT (2.9% vs 25.0%, p=0.006). Patients already on CPD presented a higher LVEF at 6-months follow-up (62.5% vs 59.2%, p=0.017). Patients submitted to AHT and anthracycline therapy had higher risk of developing CVT. In the AHT sub-group, pre-treatment with CPD was significantly associated with a lower prevalence of CVT. These results highlight the importance of cardio-oncology evaluation and strengthen the value of primary prevention.

Keywords

References

  1. World Health Organization International Agency for Research on Cancer (IARC). GLOBOCAN 2020: estimated cancer incidence, mortality and prevalence worldwide in 2020. 2020. Accessed 2022 Jul 23. Available from: https://gco.iarc.fr/today/fact-sheets-cancers
  2. Naaktgeboren WR, Linschoten M, de Graeff A, et al. Long-term cardiovascular health in adult cancer survivors. Maturitas 2017;105:37-45. DOI: https://doi.org/10.1016/j.maturitas.2017.05.014
  3. Pondé NF, Lambertini M, de Azambuja E. Twenty years of anti-HER2 therapy-associated cardiotoxicity. ESMO Open 2016;1:e000073. DOI: https://doi.org/10.1136/esmoopen-2016-000073
  4. Slamon D, Eiermann W, Robert N, et al. Adjuvant trastuzumab in HER2-positive breast cancer. N Engl J Med 2011;365:1273-83. DOI: https://doi.org/10.1056/NEJMoa0910383
  5. Yu AF, Yadav NU, Lung BY, et al. Trastuzumab interruption and treatment-induced cardiotoxicity in early HER2-positive breast cancer. Breast Cancer Res Treat 2015;149:489-95. DOI: https://doi.org/10.1007/s10549-014-3253-7
  6. Piccart-Gebhart MJ, Procter M, Leyland-Jones B, et al. Trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer. N Engl J Med 2005;353:1659-72. DOI: https://doi.org/10.1056/NEJMoa052306
  7. Yamaguchi N, Fujii T, Aoi S, et al. Comparison of cardiac events associated with liposomal doxorubicin, epirubicin and doxorubicin in breast cancer: a Bayesian network meta-analysis. Eur J Cancer 2015;51:2314-20. DOI: https://doi.org/10.1016/j.ejca.2015.07.031
  8. Zamorano JL, Lancellotti P, Rodriguez Muñoz D, et al. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: The Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC). Eur Heart J 2016;37:2768-801. DOI: https://doi.org/10.1093/eurheartj/ehw211
  9. Lyon AR, López-Fernández T, Couch LS, et al. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J 2022;43:4229-61. DOI: https://doi.org/10.1093/eurheartj/ehac244
  10. Cardinale D, Colombo A, Bacchiani G, et al. Early detection of anthracycline cardiotoxicity and improvement with heart failure therapy. Circulation 2015;131:1981-8. DOI: https://doi.org/10.1161/CIRCULATIONAHA.114.013777
  11. Barros-Gomes S, Herrmann J, Mulvagh SL, et al. Rationale for setting up a cardio-oncology unit: our experience at Mayo Clinic. Cardiooncology 2016;2:5. DOI: https://doi.org/10.1186/s40959-016-0014-2
  12. Čelutkienė J, Pudil R, López-Fernández T, et al. Role of cardiovascular imaging in cancer patients receiving cardiotoxic therapies: a position statement on behalf of the Heart Failure Association (HFA), the European Association of Cardiovascular Imaging (EACVI) and the Cardio-Oncology Council of the European Society of Cardiology (ESC). Eur J Heart Fail 2020;22:1504-24. DOI: https://doi.org/10.1002/ejhf.1957
  13. Plana JC, Galderisi M, Barac A, et al. Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imag 2014;15:1063-93. DOI: https://doi.org/10.1093/ehjci/jeu192
  14. Martins de Carvalho M SC. Cardio-oncology: the future is now! Rev Port Cardiol 2022;41:985-6. DOI: https://doi.org/10.1016/j.repc.2022.08.005
  15. Čelutkienė J, Plymen CM, Flachskampf FA, et al. Innovative imaging methods in heart failure: a shifting paradigm in cardiac assessment. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2018;20:1615-33. DOI: https://doi.org/10.1002/ejhf.1330
  16. Caspani F, Tralongo AC, Campiotti L, et al. Prevention of anthracycline-induced cardiotoxicity: a systematic review and meta-analysis. Intern Emerg Med 2021;16:477-86. DOI: https://doi.org/10.1007/s11739-020-02508-8
  17. Vaduganathan M, Hirji SA, Qamar A, et al. Efficacy of neurohormonal therapies in preventing cardiotoxicity in patients with cancer undergoing chemotherapy. JACC CardioOncol 2019;1:54-65. DOI: https://doi.org/10.1016/j.jaccao.2019.08.006
  18. Fang K, Zhang Y, Liu W, et al. Effects of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use on cancer therapy-related cardiac dysfunction: a meta-analysis of randomized controlled trials. Heart Fail Rev 2021;26:101-9. DOI: https://doi.org/10.1007/s10741-019-09906-x
  19. Pinho JF, Nunes JP, Paiva M, et al. Is dyslipidemia a risk factor for trastuzumab-induced cardiotoxicity in breast cancer patients? - A Systematic review and meta-analysis. Port Cardiol 2023. Online Ahead of Print. DOI: https://doi.org/10.1016/j.repc.2022.10.016

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