Abstract 9546: Cancer Therapeutics-Related Cardiac Dysfunction is Associated With High Risk of Cancer-Related Mortality in Patients Treated With Anthracycline-Containing Chemotherapy

Abstract

Background: Cancer therapeutics-related cardiac dysfunction (CTRCD) is a concerning problem in anthracycline-containing chemotherapy. However, the impact of CTRCD on cancer-related mortality is remained to be elucidated. Methods: Consecutive 174 patients planned for anthracycline-containing chemotherapy were enrolled. Echocardiography and blood test were performed at baseline, 3 months, 6 months, 12 months after starting chemotherapy, and after that every 3 months until cardiotoxic chemotherapy was completed. Results: Of 174 patients, CTRCD was developed in 16 patients (CTRCD group, median onset was 8 months), and the other patients (no-CTRCD group) showed normal left ventricular ejection fraction (LVEF). CTRCD group showed higher levels of peak troponin I (0.05 [0.04-0.16] ng/ml vs. 0.02 [0.02-0.04] ng/ml, P<0.001), peak B-type natriuretic peptide (59 [26-161] pg/ml vs. 25 [15-41] pg/ml, P=0.001), and lower LVEF at 12-month (54.1±7.5% vs. 64.6±4.8%, P<0.001) compared to no-CTRCD group. When we set the cut-off value of troponin I at 0.03 ng/ml, sensitivity, specificity, and area under the curve to predict CTRCD were 88%, 72%, and 0.792, respectively. In CTRCD group, 4 patients (25%) discontinued cardiotoxic chemotherapy due to CTRCD, and 12 patients (75%) showed recovered LVEF to more than 53%. In total study subjects, no patients presented cardiac death in follow up period (median 1056 days), but 22 patients (13%) died due to cancer progression. Kaplan-Meier analysis revealed that CTRCD group showed higher cancer-related mortality compared to no-CTRCD group (figure, P<0.001). Multivariate Cox-proportional hazard analysis showed that CTRCD was an independent risk factor for cancer death (HR 4.639, 95%CI [1.691-12.730], P=0.003). Conclusion: The development of CTRCD was associated with high risk of cancer death, but not with cardiac death. Cardioprotective treatment and careful cancer monitoring are required to the patients with CTRCD.