Cardiotoxic effects of gemcitabin/cisplatin vs paclitaxel/carboplatin first-line chemotherapy in patients with advanced non-small cell lung cancer

Background

Introduction: The aim of this study was to establish the frequency of cardiotoxicity in the patients treated with the first-line chemotherapy (gemcitabine/cisplatin and paclitaxel/carboplatin), with or without the history of cardiovascular co-morbidities.

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Methods

This prospective study included 240 patients with cytologically or histopathologically confirmed NSCLC at the clinical stages III and IV, divided into subgroups according to the type of chemotherapy and the presence of cardiovascular co-morbidities. Physical examination, electrocardiogram and NT-proBNP and troponin T levels were performed before and after the application of each cycle of chemotherapy. Echocardiography was performed before and after chemotherapy, as well as in the follow-up examinations every three months, a total of one year. Cardiac toxicity was determined based on the presence of cardiovascular symptoms, changes in the electrocardiogram, elevated levels of NT-proBNP and troponin T and a decrease in left ventricular ejection fraction.

Results

In the study group 184 patients (76.7%) were male. The most frequent was adenocarcinoma, in 120 patients (50%). Most common cardiovascular toxic effects were increase in the level of NT-proBNP (44.85%), cardiac arrhythmias (26.18%), venous thromboembolism (19.9%) and decreased left ventricular ejection fraction (6.96%). Patients treated with the first-line chemotherapy gemcitabine/cisplatin developed cardiotoxicity more frequently if they had a former history of cardiovascular diseases, but without statistical significance. Patients treated with the first-line chemotherapy paclitaxel/carboplatin developed cardiotoxicity more frequently if they had a former history of cardiovascular diseases, and the statistical significance was registered at the first follow-up examination in stage III NSCLC patients (p = 0.037).

Conclusions

Chemotherapy induced cardiotoxocity frequently occurs in patients with cardiovascular co-morbidities. Balance between the effectiveness of chemotherapy and the risk of cardiotoxicity requires close cooperation oncologists and cardiologists, with the aim of creating individual therapy for each patient

Clinical trial identification

Legal entity responsible for the study

N/A

Funding

The Faculty of Medicine Novi Sad

Disclosure

All authors have declared no conflicts of interest.