HF from cardiotoxic breast cancer therapies may confer better prognosis vs. other causes
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Women who developed HF following cardiotoxic breast cancer treatment had fewer comorbidities and better overall 5-year prognosis compared with women who developed HF for other reasons, researchers reported.
“Anthracycline- and trastuzumab-based chemotherapy are cardiotoxic, contributing to an increased risk of HF in early-stage breast cancer survivors,” Husam Abdel-Qadir, MD, PhD, scientist at Women’s College Research Institute and cardiologist at Women’s College Hospital in Toronto, and colleagues wrote. “While several studies report a high incidence of HF following early-stage breast cancer chemotherapy, it remains unclear if this has similar outcomes as HF from other causes.”
Researchers in Ontario, Canada, utilized administrative databases to identify 804 women who were diagnosed with HF after receiving early-stage cardiotoxic breast cancer treatment. The women were categorized based on exposure to anthracycline (n = 312), trastuzumab (Herceptin, Genentech; n = 112) or both (n = 380). Individuals were then age-matched with at least three controls with HF from other causes to evaluate differences in baseline characteristics.
Researchers then performed a secondary age-matched analysis to assess prognosis after HF onset.
Compared with 2,411 cancer-free age-matched controls with HF, women who received early-stage breast cancer treatment and later developed HF were more likely to be diagnosed as outpatients as opposed to in-hospital or in the ED (P < .001) and were less likely to have preexisting ischemic heart disease (P < .001), atrial fibrillation (P = .003), hypertension (P < .001), diabetes (P < .001) and other non-CV comorbidities.
In the secondary age-matched analysis, researchers observed that women who received anthracycline for early-stage breast cancer treatment had a similar 5-year incidence of HF hospitalization compared with cancer-free controls (16.5% vs. 17.1%).
The 5-year incidence of HF hospitalization was lower among women treated with trastuzumab (9.7% vs. 16.4%; P = .03) and women treated with both anthracycline and trastuzumab for early-stage breast cancer (2.7% vs. 10.8%; P < .001) compared with cancer-free controls with HF.
“Trastuzumab-associated cardiomyopathy may have better outcomes because it is often reversible, in contrast to the less-reversible cardiotoxicity that is classically associated with anthracyclines,” Abdel-Qadir and colleagues wrote.
Additionally, the 5-year incidence of CV death was 2.9% among women who developed HF after being treated with anthracycline compared with 9.5% among cancer-free controls, and 1.7% for women treated with trastuzumab vs. 4.3% among controls.
“This study provides important context to such data. Although trastuzumab-treated women are most likely to be diagnosed with HF, the subsequent cardiovascular prognosis after its recognition is relatively good,” the researchers wrote. “Thus, we highlight an important distinction between the incidence of cardiotoxicity and its associated consequences, a concept that may be underappreciated in cardio-oncology. This has important implications considering the current motivation for continuing trastuzumab after development of stage B HF.”
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