Usefulness of the baseline risk assessment guidelines to predict cancer therapy-related cardiac dysfunction in early-stage HER2 positive breast cancer

Abstract

Abstract Introduction Treatment of HER 2-positive breast cancer (HER2+BC) with anthracyclines and HER2-targeted therapy is associated with a high incidence of cancer therapy-related cardiac dysfunction (CTRCD). Baseline risk assessment is crucial to determine patients at high risk of developing CTRCD. Heart Failure Association-International Cardio-Oncology (HFA-ICOS) risk stratification has recently been developed but validation with the new definition of CTRCD is needed (1). Purpose To investigate whether the HFA-ICOS baseline risk stratification is useful to identify patients at risk for CTRCD in patients with early-stage HER2+BC. Methods 95 patients with early-stage HER2+BC were consecutively included in a specialized cardio-oncology unit. In this cohort, patients with previous exposure to antineoplastic treatment, patients with left ventricular ejection fraction (LVEF) < 50% and patients with moderate-severe valvular heart disease had been excluded. All patients underwent a baseline echocardiography study and every 3 months until the end of the chemotherapy. Ultrasensitive troponin I was determined before and immediately after each cycle of chemotherapy. Results In our cohort, 48.4% of patients received sequential treatment with anthracyclines and anti-HER2 therapy, while 51.6% received anti-HER2 therapy without anthracyclines. HFA-ICOS baseline risk assessment identified 40 (42,1%) patients with low risk, 27 (28,4%) with moderate risk and 28 (29,5%) with high risk of CTRCD. Table 1 showed the distribution of HFA-ICOS risk factors in our cohort. Only 1 patient with high risk and 3 patients with moderate risk received cardioprotective drugs. At a median follow-up of 13,6 months, 38 patients (40%) did not develop CTRCD, 53 (55,8%) mild-CTRCD, 3 (3,2%) moderate-CTRCD, 1 (1,1%) severe-CTRCD. 3 out of the 4 patients who presented with moderate or severe CTRCD were properly identified as moderate or high risk. However, 52,5% of patients with low risk of CTRCD developed some degree of CTRCD and 19 out of the 38 patients (69,4%) who did not present CTRCD were wrongly identified as moderate or high risk. Table 2 showed the relation between HFA-ICOS risk assessment and the development of CTRCD. Conclusions Treatment of early-stage HER2+BC was associated with a high incidence of CTRCD. In our cohort of early-stage HER2+BC, HFA-ICOS baseline risk assessment was useful in identifying patients at risk of developing moderate or severe CTRCD, but was not useful in identifying patients at low risk of CTRCD.HFA-ICOS risk factors and CTRCDHFA-ICOS risk assessment and CTRCD