SPC365

Cardiotoxicity in breast cancer patients – risk factors and role of cardioprotective drugs

Session: Comunicações Orais (Sessão 16) - Doença CV em Populações Especiais
Speaker: Miguel Martins de Carvalho

Congress: CPC 2022
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 Cardoso Torres; Carlos Xavier Resende; Pedro Grilo Diogo; 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"> Recent advances in cancer treatment have led to improved survival, albeit with cardiovascular adverse effects being some of the most frequent and feared consequences. Patient&rsquo;s risk stratification, prevention and treatment are still to be fully elucidated. Our aim was to evaluate the risk and therapy of cardiotoxicity (CT) secondary to cancer treatment in a subset of patients with breast cancer (BC).</span></span></span></span></p>

<p style="text-align:justify">&nbsp;</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 collected a retrospective cohort of female with BC treated with conventional chemotherapy (CHT) and/or anti-HER2-targeted therapies (AHT) referred to Cardio-oncology consultation from January 2017 to November 2019. All patients were evaluated before CHT and at least at 3, 6 and 12-months with echocardiogram and cardiac biomarkers, namely high sensitivity troponin I (hs-cTnI) and brain natriuretic peptide (BNP). CT was defined as left ventricle ejection fraction (LVEF) under 50% or decline of at least 10% in LVEF during follow-up. As cardioprotective drugs (CPD) were considered renin-angiotensin-aldosterone system inhibitors and beta-blockers.</span></span></span></span></p>

<p style="text-align:justify">&nbsp;</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 174 women were enrolled with mean age 51.4 </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"> 11.1 year-old. As for the cardiovascular risk factors (CVRF) 24.7% had hypertension, 32.2% dyslipidaemia, 9.8% diabetes and 24.1% were smokers or previous smokers. 36.4</span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Gill Sans MT&quot;,sans-serif">% of patients were already on CPD before CHT. </span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Gill Sans MT&quot;,sans-serif">The majority of patients had a high or very-high CT risk score (98.3% with score &ge; 5). All patients were submitted to CHT, whether adjuvant (43.5%), neoadjuvant (54.3%) or palliative (2.2%) and 15.8% were submitted to radiotherapy (RT). Anthracyclines (AC) and </span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Gill Sans MT&quot;,sans-serif">AHT were applied to 81.5% and 41.8% of patients, respectively, with 26.6% of patients taking both. At presentation, 99.4% had normal cardiac function with mean LVEF of 62.9%; mean hs-cTnI and BNP were 3.3 ng/L and 35.9 pg/mL, respectively. During a </span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Gill Sans MT&quot;,sans-serif">median follow-up of 16 months, 10.4% of patients developed CT, leading to initiation or titration of CPD in 83.3% and treatment interruption in 22.2%; most of them recovered (94.1%). During treatment there was a significantly increase of hs-cTnI (mean - 18.6 ng/L at 3 months, p&lt;0.001) and a decrease of LVEF during follow-up (decrease of 2.2% at 12 months, p&lt;0.001). Both AHT and AHT plus AC were significantly associated with CT (p=0.002 and p=0.002, respectively), with an extremely high prevalence in the latter group (24.5%). Nor CVRF neither RT raised the risk of CT. Although patients on CPD didn&rsquo;t had lower prevalence of CT (7.9% vs 11.8%, p=0.421), they presented a non-significative higher rate of cardiac function recovery (100% vs 66.7%, p=0.084). </span></span></span></span></p>

<p style="text-align:justify">&nbsp;</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 or AHT plus AC were at higher risk of developing CT. This and the significant LVEF decline during follow-up highlighted the importance of long-term-monitoring of these patients. Although needing further validation CPD seemed to be associated with cardiac recovery.</span></span></p>