Echocardiographic and biological prospective assessment of cardiotoxicity in patients with breast cancer receiving taxanes, anthracyclines and/or trastuzumab

Abstract

Purpose: To evaluate cardiotoxicity in women with breast cancer treated with taxanes, anthracyclines and/ or trastuzumab using clinical, echocardiographic and biological parameters. Methods: This is a prospective observational study in women with new diagnosis of breast cancer who are candidates to receive anthracyclines, taxanes and/ or trastuzumab therapy. Cardiac risk factors, clinical examination and concomitant therapy at baseline were recorded. Our protocol assessment included clinical, echocardiographic (left ventricular ejection fraction (LVEF) measured with biplane Simpson's method and with Teichholz formula) and biological parameters (B-type natriuretic peptide (BNP) and carbohydrate antigen 125 (CA125)) at baseline, six and twelve months (baseline, 3, 6, 9 and 12 months in cases of treatment with trastuzumab). Cardiotoxicity was defined as a reduction of LVEF ≥5% to <55% with symptoms of heart failure or an asymptomatic reduction of LVEF ≥10% to <55%. Patients with LVEF < 50% at baseline were excluded. Results: A total of 174 women with breast cancer were consecutively included from November 2011 to December 2012. Mean age was 55±12 years (range 27-84). HER 2 protein overexpression was found in 51 patients (29%). Clinical characteristics at baseline were: hypertension 27%, diabetes mellitus 6.3%, chronic ischaemic cardiopathy 4.6% and history of heart failure 1.1%. Only seven patients developed cardiotoxicity (4%), and five of them were on trastuzumab treatment. There were no significant changes in echocardiographic parameters (LVEF decreased by Teichholz's from 69±7 to 68±6%, p=0.9; and by Simpson's from 67±7% to 64±6%, p = 0.3) and heart failure biomarkers over 12 months (median BNP 26, range 4-492 and 29.5, range 5-262, at baseline and 12-months, respectively (p=0.9); median CA125 13.1 (range 2.7-81) and 14.2 (range 15-33) at baseline and 12-months, respectively (p=0.7)). Conclusions: In this cohort of women with breast cancer no significant differences in echocardiographic and biomarker variables from baseline at one year follow-up were observed. Our results also showed a lower incidence of cardiotoxicity compared with previous series reported.