Abstract 370P
Background
Gemcitabine- and fluoropyrimidine (FP)-based chemotherapies are recommended treatment for bliopancreatic cancer. Cardiotoxicity has not been well studied in this population of patients (pts).
Methods
Pts with good performance status (PS<2) were prospectively monitored for cardiovascular symptoms. An electrocardiogram (EKG) and measure of left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) using 2D echo were performed before chemotherapy and repeated regularly during and after treatment. The primary end point was defined as the onset of clinical cardiotoxicity (CTX) defined as the occurrence of symptoms suggestive of cardiac toxicity, while subclinical cardiotoxicity (STX) was defined as worsening ≥10% in LVEF and/or GLS or abnormal EKG. IBM SPSS Statistics version 26.0 was used for analyses.
Results
This study included Fifty-eight pts (60% male, 77% smokers) with pancreatic cancer (53) or vaterian ampulloma (5), with a mean age of 64±7.8 years and a mean BMI of 21.7±3.5 kg/m2. 65.5% pts had diabetes, 48.3% arteriel hypertension, 37.9% dyslipidemia. 5 pts had cardiac comorbidity (2 atrial fibrillation, 2 myocardial infraction and 1 complete left bundle branch block. Mean baseline LVEF was 62.7±4.5%. 3 pts were offered adjuvant chemotherapy after DPC, and the remaining (55) had received palliative chemotherapy. The mean number of cycles was 5.1 for mFolfirinox, 4.6 for Gemcitabine, 5.1 for Capox, 10.2 for capecitabine. 6 pts (10.3%) experienced CTX while receiving chemotherapy : 1 sinus tachycardia, 1 sinus bradycardia, 2 chest pain, 1 supraventricular tachycardia, 1 heart failure. multivariate analysis showed that age (OR = 1.51), male sex (OR = 1.65), smoking (OR = 2.05) and history of cardiac comorbidity (OR = 1.70) were associated with a higher risk of CTX. Regarding STX, a difference was observed between pre-FP and post-FP EKGs in terms of increased heart rate (p=0.011) and QT prolongation (p=0.041). There was only one subclinical pericardial effusion with Gemcitabine.
Conclusions
A high incidence of CTX has been observed with FP-based chemotherapy, highlighting the importance of careful monitoring of cardiac symptoms, particularly in pts with risk factors. There is no role for 2D echo to detect STX in this patient population.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.