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Anthracycline-based chemotherapy leads to diastolic dysfunction in many patients with breast cancer
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Patients with breast cancer who undergo anthracycline-based chemotherapy have an increased risk for developing diastolic dysfunction, according to study results.
The risk for diastolic dysfunction appeared greater in women who were older or who had a higher BMI, results also showed.
Although anthracyclines are often used in adjuvant and metastatic breast cancer treatment regimens, their use is limited because of their association with cardiotoxicity. Further, trastuzumab (Herceptin, Genentech) — a major advancement in the treatment of breast cancer, — after anthracyclines increases the risk for cardiotoxicity, specifically heart failure and left ventricle dysfunction, according to study background.
However, the risk for diastolic dysfunction, which is the precursor of a more intense cardiac problem, is not well understood in patients treated with anthracyclines, trastuzumab, or both.
Jose M. Serrano, MD, a cardiologist at the Hospital Universitario de Fuenlabrada in Madrid, and colleagues sought to assess the incidence, evolution and predictors of diastolic dysfunction among patients with breast cancer treated with anthracyclines.
The analysis included 100 patients treated with anthracycline chemotherapy between 2008 and 2010 at a single institution. All patients received an echocardiogram and cardiac biomarker measurement at baseline, at the completion of their anthracycline-based therapy, and at 3 and 9 months following treatment.
Researchers followed 15 patients who also received trastuzumab with two additional visits at 6 and 12 months.
Fifteen patients from the original cohort had diastolic dysfunction at baseline and were excluded.
Median follow-up was 12 months (interquartile range [IQR], 11.1-12.8).
At the end of the follow-up, 49 patients (57.6%) developed diastolic dysfunction that remained persistent in 36 (73%) of those patients through their final follow-up. Diastolic dysfunction reversed in the other 13 patients (27%) by the conclusion of the study.
Among those patients with diastolic dysfunction, four developed cardiotoxicity (left ventricle dysfunction, n = 3; sudden cardiac death, n = 1). No patients with normal diastolic function developed systolic dysfunction during follow-up.
Older age (OR = 1.12; 95% CI, 1.03-1.19) and a higher BMI (OR=1.19; 95% CI, 1.04-1.36) increased the risk for diastolic dysfunction related to the anthracyclines. Patients aged 50 years or older were four times more likely to develop diastolic dysfunction following treatment than those aged younger than 50 years (OR = 4.1; 95% CI, 1.62-10.38). Further, diastolic dysfunction occurred almost three times as often in overweight patients (OR = 2.8; 95% CI, 0.95-8.22) and more than seven times as often in obese patients (OR = 7.6; 95% CI, 2.1-26.9).
“Our findings show that diastolic dysfunction is common after anthracycline-based chemotherapy, particularly in older patients and those with higher BMI,” Serrano said in a press release. “By understanding the risk factors for anthracycline cardiotoxicity, we may be able to identify which breast cancer patients may benefit from more intensive monitoring programs.”
Gabriel Hortobagyi
The findings indicate that diastolic dysfunction occurs regularly enough to enhance surveillance approaches, according to Gabriel Hortobagyi, MD, FACP, a professor of medicine in the department of medical oncology at The University of Texas MD Anderson Cancer Center and a member of the editorial board of The Oncologist.
“Subclinical cardiac dysfunction after treatment with anthracyclines and trastuzumab is more common than previously thought,” he said in a press release. “Careful monitoring and utilization of appropriate, non-invasive testing will enhance patient safety.”– by Anthony SanFilippo
Disclosure: The researchers report no relevant financial disclosures.
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