309 - Delayed cardiac toxicity in breast cancer patients treated with adjuvant or neoadjuvant chemotherapy (including anthracyclines) and trastuzumab

Date 28 September 2012
Event ESMO Congress 2012
Session Publication Only
Topics Anti-Cancer Agents & Biologic Therapy
Complications of Treatment
Breast Cancer
Presenter Audrey Mailliez
Authors A. Mailliez1, N. Kotecki2, C. Kouakam3, C. Fournier4, J. Bonneterre5
  • 1Breast Department, Centre Oscar Lambret, 59000 - LILLE/FR
  • 2Breast Cancer Departement, Centre Oscar Lambret, 59000 - LILLE/FR
  • 3Soins Externes, Centre Oscar Lambret, 59000 - Lille/FR
  • 4Biostatistics, Centre Oscar Lambret, 59000 - Lille/FR
  • 5Centre Oscar Lambret, Université Lille Nord de France, FR-59020 - Lille CEDEX/FR

Abstract

New treatments in the (neo) adjuvant settings for HER2 positive breast cancer have recently changed their prognosis due to the systematic use of Trastuzumab (T). Progress however has been associated with a risk of cardiac toxicity. Since the incidence of cardiotoxicity is low and inconsistent across the 5 major adjuvant trials, we undertook a study to determine the cardiotoxicity rate of adjuvant or neoadjuvant sequential chemotherapy (3 FEC 100-3 Docetaxel) and T in non selected breast cancer pts treated at the Oscar Lambret Center between 2005-2007 and who did not relapse.

Patients (pts) and methods

121 pts met the inclusion criteria and were invited for a cardiac evaluation. 79 accepted and had a clinical examination, an Electrocardiogram (ECG) and an isotopic or echocardiographic measurement of Left Ventricular Ejection Fraction (LVEF). We also retrospectively collected, LVEF values at chemotherapy initiation, at T initiation, and after 3, 6, 9 and 12 months of T. Cardiotoxicity was defined as a decrease in LVEF of more than 10% or a level of LVEF less than 55% or clinical or ECG symptoms. The 33 pts not responding to the convocation had similar characteristics to those analysed.

Results

51 pts received 1 year T, 7 pts had 6 months T and 21 pts stopped T before 1 year because of a decrease in LVEF. Median follow up was 5.1 years (3.2 to- 6.5). 66 pts had at least 4 evaluations and were considered evaluable. No pts experienced clinical or ECG symptoms. 30 pts always had a normal LVEF. 36 pts (55%) had a normal initial LVEF but a decrease during follow up; 20% appeared more than 6 months after initiation. 11 pts (16%) had previously experienced a decrease in LVEF with anthracyclines, eight of whom also had cardiotoxicity during T. No risk factor of cardiac disease was observed in pts with cardiotoxicity. No correlation was found with age, side of the tumor, previous radiotherapy. Cardiotoxicity was more frequently observed in pts with ER negative tumors (74% vs 39%). At the time of the last evaluation, no abnormal LVEF was observed.

Conclusion

The cardiotoxiciy rate was unexpectedly high in these non selected pts. Nevertheless, LVEF remained normal after a median follow up of 5.1 year.

Disclosure

All authors have declared no conflicts of interest.