Abstract 213P
Background
Cardiotoxicity (CTx) associated with cancer treatments may mitigate its benefit and limit therapeutic options. Increasing evidence suggests a significant role for high-sensitivity troponin (hs-cTn) and type-B natriuretic peptide (BNP) in the detection of CTx and in the therapeutic orientation of cancer patients. The objective of this work is to evaluate the predictive role of these biomarkers in the detection of CTx and, more specifically, the predictive role of hs-cTn in cardioprotective Tx orientation.
Methods
Unicentric retrospective study of 185 breast cancer patients treated with neoadjuvant and adjuvant chemotherapy (ChT) and anti-HER2 therapy, from January 2017 to September 2019. All patients were evaluated by ECG, TTE and analytical study including the values of hs-cTn and BNP before the start of treatment and up to 12 months after. CTx was defined by a decline in ejection fraction (EF) >10% from baseline or EF <50%.
Results
The median age was 50 years of age (26-76). The majority of patients (89.2%) belonged to the high-risk group according to the Cardiotoxicity Risk Score. ChT scheme containing anthracyclines (AC) was used in 82% of the patients, with 42% undergoing anti-HER2 Tx. It was found that 38 (21.3%) and 9 (5.1%) patients had a significant increase in hs-cTn (≥34 ng / L) and BNP (≥100 pg/ mL), respectively. CTx occurred in 13 (7.1%) patients, 11 (84.6%) of whom were undergoing antiHER2 Tx and 2 (15.4%) AC. Anti-HER2 Tx was significantly associated with the development of CTx (p = 0.001). The same was not true for the increase in hs-cTn (p = 0.56) and BNP (p = 0.60). On the other hand, the variation in the mean values of hs-cTn and EF was significant at the 3rd (p = 0.001) and 12th month (p = 0.009), respectively, while that of the BNP was greater from the 3rd to the 6th month (p = 0.423). In the subgroup of patients with elevated hs-cTn, the institution of cardioprotective Tx appeared to be associated with a decrease in the occurrence of CTx (p = 0.03).
Conclusions
Periodic monitoring of hs-cTn and BNP values combined with the assessment of EF in patients with breast cancer undergoing ChT treatment with AC and / or anti-HER2 Tx will identify patients at risk of CTx in a timely manner and allow early implementation of cardioprotective strategies.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.