Trastuzumab – ABC CARDIOL

ABCHF

Review Article

Asymptomatic Ventricular Dysfunction and HFrEF Secondary to Classic Chemotherapy

Monica S. Avila et al. Deborah de Sá Pereira Belfort Silvia Marinho Martins Ludhmila Abrahão Hajjar

Introduction

Advances in oncology, such as better access to the health care system, earlier cancer diagnosis, and new chemotherapies, have led to longer survival of patients with cancer over the last decades. However, this population is vulnerable to drug-related adverse cardiovascular events, like cardiomyopathy, which leads to heart failure and impairs survival and quality of life.^, Among different classes of chemotherapeutic agents, classically anthracyclines and trastuzumab stand out as the most related to cardiomyopathy. Anthracyclines may cause cardiac dysfunction in cancer survivals in 9% of cases depending on risk factors and cumulative dose, and trastuzumab may cause it in 18.6% of cases with adjuvant chemotherapy.^,

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Original Article

Left Ventricular Regional Wall Motion Abnormality is a Strong Predictor of Cardiotoxicity in Breast Cancer Patients Undergoing Chemotherapy

Márcio Vinícius Lins de Barros et al. Ariane Vieira Scarlatelli Macedo Sebastian Imre Sarvari Monica Hermont Faleiros … Patricia Tavares Felipe Jose Luiz Padilha Silva Thor Edvardsen

Abstract

Background:

Chemotherapeutic agents of anthracyclines class and humanized monoclonal antibodies are effective treatments for breast cancer, however, they present a potential risk of cardiotoxicity. Several predictors have been recognized as predictors in the development of cardiac toxicity, and the evaluation of left ventricular segmental wall motion abnormalities (LVSWMA) has not been studied.

Objective:

To analyze prospectively the role of LVSWMA among echocardiographic parameters in the prediction of development of cardiotoxicity in breast cancer patients undergoing treatment with chemotherapy.

Methods:

Prospective cohort of patients diagnosed with breast cancer and in chemotherapy treatment with potential cardiotoxicity medications including doxorubicin and trastuzumab. Transthoracic echocardiograms including speckle tracking strain echocardiography were performed at standard times before, during and after the treatment to assess the presence (or lack thereof) of cardiotoxicity. Cardiotoxicity was defined by a 10% decrease in the left ventricular ejection fraction, on at least one echocardiogram. Multivariate logistic regression models were used to verify the predictors related to the occurrence of cardiotoxicity over time.

Results:

Of the 112 patients selected (mean age 51,3 ± 12,9 years), 18 participants (16.1%) had cardiotoxicity. In the multivariate analysis using the logistic regression model, those with LVWMA (OR = 6.25 [CI 95%: 1.03; 37.95], p < 0,05), LV systolic dimension (1.34 [CI 95%: 1.01; 1.79], p < 0,05) and global longitudinal strain by speckle tracking (1.48 [CI 95%: 1.02; 2.12], p < 0,05) were strongly associated with cardiotoxicity.

Conclusion:

In the present study, we showed that LVWMA, in addition to global longitudinal strains, were strong predictors of cardiotoxicity and could be useful in the risk stratification of these patients.

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Original Article

Global Longitudinal Strain Accuracy for Cardiotoxicity Prediction in a Cohort of Breast Cancer Patients During Anthracycline and/or Trastuzumab Treatment

Eliza de Almeida Gripp et al. Gabriela Escudini de Oliveira Luiz Augusto Feijó Marcelo Iorio Garcia … Sergio Salles Xavier Andréa Silvestre de Sousa

Abstract

Background:

The high cardiotoxicity morbidity and mortality rates associated with the antineoplastic therapy for breast cancer could be reduced with the early use of cardioprotective drugs. However, the low sensitivity of left ventricular ejection fraction limits its use in that preventive strategy. New parameters, such as global longitudinal strain, are being used in the early detection of contractile function changes.

Objectives:

To assess the incidence of cardiotoxicity in patients treated for breast cancer, the independent factors associated with that event, and the ability of strain to identify it early.

Methods:

Prospective observational study of consecutive outpatients diagnosed with breast cancer, with no previous antineoplastic treatment and no ventricular dysfunction, who underwent anthracycline and/or trastuzumab therapy. The patients were quarterly evaluated on a 6- to 12-month follow-up by an observer blind to therapy. Cox regression was used to evaluate the association of cardiotoxicity with clinical, therapeutic and echocardiographic variables. A ROC curve was built to identify the strain cutoff point on the third month that could predict the ejection fraction reduction on the sixth month. For all tests, the statistical significance level adopted was p ≤ 0.05.

Results:

Of 49 women (mean age, 49.7 ± 12.2 years), cardiotoxicity was identified in 5 (10%) on the third (n = 2) and sixth (n = 3) months of follow-up. Strain was independently associated with the event (p = 0.004; HR = 2.77; 95%CI: 1.39-5.54), with a cutoff point for absolute value of -16.6 (AUC = 0.95; 95%CI: 0.87-1.0) or a cutoff point for percentage reduction of 14% (AUC = 0.97; 95%CI: 0.9-1.0).

Conclusion:

The 14% reduction in strain (absolute value of -16.6) allowed the early identification of patients who could develop anthracycline and/or trastuzumab-induced cardiotoxicity.

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Clinical Update

Interaction between specialties: dilated cardiomyopathy and HER2-positive breast Cancer

Solange Moraes Sanches et al. Jairo Montemor Augusto Silva

Basic research may result in unexpected benefit in terms of progress in the understanding of mechanisms responsible for different diseases and their potential treatment alternatives. This is seen, for instance, when a specific situation, defined in clinical practice, may be translated into laboratory findings which suggest a new therapy for an unrelated disease, representing the inverse of the more usual bench-to-bedside path. During the past few years, the use of the monoclonal antibody trastuzumab, in the adjuvant and therapeutic context, has become of fundamental importance in the treatment of breast cancer with amplification/overexpression of HER2, resulting in significant increase in survival rates. The observation that trastuzumab also induces cardiotoxicity, and the identification of mechanisms involved in this side effect, have allowed the investigation of these factors as a therapeutic alternative for dilated cardiomyopathy, in a highly interesting fashion.

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Asymptomatic Ventricular Dysfunction and HFrEF Secondary to Classic Chemotherapy

Introduction

Left Ventricular Regional Wall Motion Abnormality is a Strong Predictor of Cardiotoxicity in Breast Cancer Patients Undergoing Chemotherapy

Abstract

Background:

Objective:

Methods:

Results:

Conclusion:

Global Longitudinal Strain Accuracy for Cardiotoxicity Prediction in a Cohort of Breast Cancer Patients During Anthracycline and/or Trastuzumab Treatment

Abstract

Background:

Objectives:

Methods:

Results:

Conclusion:

Interaction between specialties: dilated cardiomyopathy and HER2-positive breast Cancer

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