SPC365

The beneficial role of cardioprotective drugs in preventing cardiotoxicity in HER2 positive breast cancer – an echocardiographic point-of-view

Session: Posters (Sessão 1 - Écran 2) - Cardio-oncologia
Speaker: Cátia Oliveira

Congress: CPC 2023
Topic: K. Cardiovascular Disease In Special Populations
Theme: 30. Cardiovascular Disease in Special Populations
Subtheme: 30.6 Cardio-Oncology
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Cátia Oliveira; Luís Santos; Ana Pinho; Pedro Palma; Alexandra Freitas; Sara Costa; André Cabrita; Catarina Marques; Ana Filipa Amador; Catarina Costa; João Calvão; Ricardo Pinto; Mariana Paiva; Carla Sousa; Filipe Macedo

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Introduction:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"> In patients with breast cancer, anti-HER2-targeted therapies (AHT) are highly associated with cancer therapy-related cardiac dysfunction (CTRCD), which is the main reason for treatment interruption. Guidelines recommend CTRCD management with cardioprotective drugs (CPD). Our aim was to evaluate risk of CTRCD 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:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Methods:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"> We retrospectively analyzed a population of breast cancer female patients treated with AHT referred to Cardio-Oncology outpatient clinic from January 2017 to November 2021. All patients were evaluated with echocardiogram, high sensitivity troponin I (hs-cTnI) and BNP before treatment initiation and at least at 3, 6 months and 12-months after finishing oncologic reatment. CTRCD was defined as LVEF&lt;50% and/or GLS variation&gt;15% 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:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Results:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"> A total of 169 patients were included with mean age of 52.3&plusmn;11.3 year-old; 50% of patients had a low baseline cardio-toxicity risk. At baseline, median hs-cTnI was 1.9 (IQRT 1.9-3.0)ng/L, median BNP was 20.8 (IQR 10.0-40,2)pg/L, mean LVEF was 62.9&plusmn;3.7% and mean GLS was -19.2&plusmn;2.4%.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">During follow-up (15.5&plusmn;5.3 months), 46% developed CTRCD with a higher prevalence in patients concurrently on anthracyclines (58.8% vs 27.3%, p&lt;0.001). CPD was initiated or titrated in 43% of patients and 4.7% needed to suspend AHT; 63.7% of CTRCD patients recovered. When comparing patients already medicated with CPD prior to CTRCD (43%) to those na&iuml;ve of CPD, the first group presented a significantly lower incidence of CTRCD [19.4% vs 38.1%, p=0.009, OR=0.39 (95%CI 0.19&ndash;0.80)]. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">LVEF at 12 months was significantly lower in the patients with CTRCD (LVEF 59% vs 61%, p= 0.026). We verified that patients with CTRCD medicated with CPD had a similar LVEF at 12 months when compared to patients with no CTRCD who were not medicated with CPD (LVEF 60% vs 61%, p=0.371). GLS at 12 months was tendentially lower between patients with and without CTRCD (GLS -17.9 vs -18.6%; p=0,055; IC 95% -0.16-1.73). The risk of developing CTRCD was 23% per patients-year.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Conclusion:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"> Patients exposed to AHT had higher risk of developing CTRCD, especially when concurrently on anthracyclines therapy. Pre-treatment with CPD was significantly associated with a lower prevalence of CTRCD and with better echocardiographic outcomes in patients who developed CTRCD. These results highlight the importance of cardiac evaluation in AHT patients and strengthen the value of primary and secondary prevention.</span></span></span></span></p>