SPC365

Preventive role of cardioprotective drugs in HER2 positive breast cancer

Session: CO 26 - Populações especiais
Speaker: Miguel Martins de Carvalho

Congress: CPC 2021
Topic: K. Cardiovascular Disease In Special Populations
Theme: 30. Cardiovascular Disease in Special Populations
Subtheme: 30.6 Cardio-Oncology
Session Type: Comunicações Orais
FP Number: ---
Authors: Miguel Martins De Carvalho; Ricardo Alves Pinto; Tânia Proença; Inês Costa; Sofia Torres; Carlos Xavier Resende; Pedro Diogo Grilo; Ana Filipa Amador; Catarina Martins da Costa; João Calvão; Carla de Sousa; Mariana Paiva; Filipe Macedo

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Gill Sans MT&quot;,sans-serif">Introduction:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Gill Sans MT&quot;,sans-serif"> In patients with breast cancer, anti-HER2-targeted therapies (AHT) are highly associated with cardiotoxicity (CT), being the main reason for treatment interruption in patients receiving adjuvant trastuzumab. Guidelines recommend regular left ventricular ejection fraction (LVEF) assessments and CT&rsquo;s management with cardioprotective drugs (CPD). However, while secondary prevention has already entered clinical practice, despite persistent unresolved questions, primary prevention is still in the research domain. Our aim was to evaluate risk of CT and the role of CPD in a subset of breast cancer patients treated with AHT.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Gill Sans MT&quot;,sans-serif">Methods:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Gill Sans MT&quot;,sans-serif"> We retrospectively analyzed a population of breast cancer female patients treated with AHT referred to Cardio-oncology consultation at a tertiary center from January 2017 to November 2019. All patients were evaluated with echocardiogram before treatment initiation and at least at 3, 6, 9 and 12-months. CT was defined as LVEF under 50% or decline of at least 10% in LVEF during follow-up. As CPD we considered renin-angiotensin-aldosterone system inhibitors and beta-blockers.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Gill Sans MT&quot;,sans-serif">Results: </span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Gill Sans MT&quot;,sans-serif">A total of 74 patients were included with mean age of 52.9 </span></span><span style="font-size:12.0pt"><span style="font-family:Symbol">&plusmn;</span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Gill Sans MT&quot;,sans-serif"> 10 year-old. Concerning cardiovascular risk factors (CVRF) 12.2% had diabetes, 33.8% dyslipidaemia, 29.7% hypertension and 23.0% were smokers or previous smokers; most patients had a high or very-high CT risk score (98.6% with score &ge; 5). Besides AHT, 66.2% and 82.2% were also on anthracyclines and radiotherapy, respectively. Patients were followed for a median follow-up of 17 months. At baseline, mean </span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Gill Sans MT&quot;,sans-serif">high sensitivity troponin I (</span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Gill Sans MT&quot;,sans-serif">hs-cTnI) was 4.1 ng/L and mean LVEF was 63.4%, with all patients with normal cardiac function. During follow-up, 18.9% of patient developed CT with a higher prevalence in patients concomitantly on anthracyclines (24.5% vs 8%, p=0.087). CPD was initiated or titrated in 85.7% of patients and 28.6% needed to suspend AHT; overall 92.9% of CT patients recovered. When comparing patients already medicated with CPD before cancer treatment (41.9%) to those na&iuml;ve of CPD, the first group present a significative lower incidence of CT [6.5% vs 27.9%, p=0.020, OR=0.18 (95% CI 0.04 &ndash; 0.87)]. When analysed all sample (with or without CT), patients already on CPD also presented a higher LVEF at 12 months follow-up (62.0% vs 59.1%, t(55)=-2.4, p=0.018), despite of similar LVEF at baseline (62.8% vs 63.8%, p=0.292). Medication with statins before chemotherapy did not reduce the risk of CT.</span></span></span></span></p>

<p><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Gill Sans MT&quot;,sans-serif">Conclusion:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Gill Sans MT&quot;,sans-serif"> Patients submitted to AHT had higher risk of developing CT, especially when concomitantly on anthracyclines therapy. Pre-treatment with CPD was significantly associated with a lower prevalence of CT and a higher LVEF at 12-months follow-up. These results highlight&nbsp;the importance of cardiac evaluation in HER2+ patients and strengthen the value of primary prevention in these patients.</span></span></p>