Effects of anthracycline, cyclophosphamide and taxane chemotherapy on QTc measurements in patients with breast cancer.

Pedro Veronese,Ludhmila Abrahão Hajjar,Francisco Carlos Da Costa Darrieux,Luciana Sacilotto,Denise Tessariol Hachul,Carolina Veronese,Tan Chen Wu,Mauricio Ibrahim Scanavacca,Claudio M Costa-Neto

doi:10.1371/journal.pone.0196763

Abstract

AimAcute and subacute cardiotoxicity are characterized by prolongation of the corrected QT interval (QTc) and other measures derived from the QTc interval, such as QTc dispersion (QTdc) and transmural dispersion of repolarization (DTpTe). Although anthracyclines prolong the QTc interval, it is unclear whether breast cancer patients who undergo the ACT chemotherapy regimen of anthracycline (doxorubicin: A), cyclophosphamide (C) and taxane (T) may present with QTc, QTdc and DTpTe prolongation.MethodsTwenty-three consecutive patients with breast cancer were followed prospectively during ACT chemotherapy and were analyzed according to their QT measurements. QTc, QTdc and DTpTe measurements were determined by a 12-lead electrocardiogram (EKG) prior to chemotherapy (baseline), immediately after the first phase of anthracycline and cyclophosphamide (AC) treatment, and immediately after T treatment. Serum troponin and B-type natriuretic peptide (BNP) levels were also measured.ResultsCompared to baseline values, the QTc interval was significantly prolonged after the AC phase (439.7 ± 33.2 ms vs. 472.5 ± 36.3 ms, p = 0.001) and after T treatment (439.7 ± 33.2 ms vs. 467.9 ± 42.6 ms, p < 0.001). Troponin levels were elevated after the AC phase (23.0 pg/mL [min-max: 6.0–85.0] vs. 6.0 pg/mL [min-max: 6.0–22.0], p < 0.001) and after T treatment (25.0 pg/mL [min-max: 6.0–80.0] vs. 6.0 pg/mL [min-max: 6.0–22.0], p < 0.001) compared to baseline values.ConclusionIn this prospective study of patients with non-metastatic breast cancer who underwent ACT chemotherapy, significant QTc prolongation and an elevation in serum troponin levels were observed.

Highlights

In addition to skin cancer, breast cancer is the most common type of cancer in women
Kitagawa et al showed that patients with breast neoplasms who underwent a chemotherapy regimen with epirubicin, cyclophosphamide and 5-fluorouracil presented with QTc interval prolongation [16]
Tanriverdi et al demonstrated that patients with breast neoplasms with HER2 expression who underwent a chemotherapy regimen with trastuzumab and anthracycline presented with QTc interval prolongation [11]

Summary

Introduction

In addition to skin cancer, breast cancer is the most common type of cancer in women. Advancements in chemotherapy strategies for breast cancer patients have contributed to high remission rates. Chemotherapy-related cardiotoxicity has been a subject of intensive research all over the world. The research characterized acute and subacute cardiotoxicity by acute coronary artery syndrome, pericarditis, myocarditis, cardiac arrhythmias, or QT interval prolongation [1, 2]. Such cardiac changes may occur during chemotherapy treatment or even up to two weeks after the conclusion of chemotherapy [3]. Chronic cardiotoxicity may result in a reduced left ventricle ejection fraction (LVEF), heart failure, or death [4]

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