BACKGROUND: Advances in chemotherapy and target therapy have made treatment of breast cancer (BC) more effective; however, survivors of BC suffer an increased burden of cardiotoxicity. The aim of this study is to determine the risk factors in a Mexican patients (pt)
METHODS:Observational study of a cohort of pt with locally BC and Her2 (+++) treated with trastuzumab (TZ). According to clinical stage, they underwent to surgery or neoadjuvant chemotherapy, scheme was at the decision of the physician. The main schemes: AC-T, EC-T, FAC-T, FEC-T, Paclitaxel, intravenous (IV) or subcutaneous TZ. The doses were according to NCCN guidelines and the route of administration of TZ was decision of the oncologist. Ventriculography was performed basally, at 4,8,12 cycles and at the end of treatment. If the pt presented a decrease in the ejection fraction>10% with/without symptoms, they received cardioprotection (metoprolol+atorvastatin). It was the oncologist decision to suspend chemotherapy as well as TZ.
RESULTS: 97 pt were included from Jan 2017 to Jan 2018, 35% presented cardiotoxicity. The only variables that presented a statistically significant for cardiotoxicity risk were normal weight, neoadjuvant treatment and IV TZ (table 1,2). Only 32.4% of the pt tolerated full doses of cardioprotective drugs. 13% of the pt with cardiotoxicity presented symptoms and 52.9% of the pt did not complete trastuzumab for 1year
Table 1.Demographic characteristics of the patients (n=97) TotalWith Cardiotoxicity (n=34)Without Cardiotoxicity (n=63)pAge, years. Mean (SD)50.36 (12.91)51.09 (12.46)49.97 (13.22)0.686*Body mass index, kg/m2. Median (range)37.98 (21.23 -63.0728.15 (21.23 - 43.84)41.58 (31.67 - 63.07)0.0001¥Hypertension, presence. n (%)18 (18.6)8 (23.5)10 (15.9)0.416Diabetes, presence. n (%)16 (16.5)8 (23.5)8 (12.7)0.251Smoking, presence. n (%)14 (14.4)2 (5.9)12 (19.0)0.128Weight. n (%) Normal3 (3.1)3 (8.8)0 (0)0.0001Overweight22 (22.7)22 (64.7)0 (0) Obestity72 (74.2)9 (26.5)63 (100) Abreviation.AJCC. American Joint Committee on Cancer 2010. / *T-student, ¥U Mann-Whitney. The rest were analized with X2
Table 2.Treatment characteristics (n=97)Systemic treatment. n (%)TotalWith Cardiotoxicity (n=34)Without Cardiotoxicity (n=63)pNeoadjunvant35 (36.1)30 (88.2)5 (7.9)<0.0001Adjuvant62 (63.9)4 (11.8)58 (92.1) Chemotherapy scheme. n (%) 0.687AC-T50 (51.5)20 (58.8)30 (49.2) EC -T40 (41.2)12 (35.3)28 (45.9) FAC-T2 (2.1)1 (2.9)1 (1.6) FEC-T2 (2.1)0 (0)2 (3.2) Paclitaxel3 (3.1)1 (2.9)2 (3.2) Acumulative dose antracicline, mg. Median (range)432 (0 - 1440)420 (0-760)432 (0-1440)0.874*Trastuzumab administration way. n (%) 0.0001Subcutaneous87 (89.7)24 (70.6)63 (100) Intravenous10 (10.3)10 (29.4)0 (0) Trastuzumab cycles. Median (range)17 (3 - 17)13 (3 - 17)17 (6 - 17)0.0001*Ejection fraction left ventricle. Median (range)67.4 (38 - 75)67.2 (38 - 74)67.4 (61 -75)0.428*Abreviation: * U Mann-Whitney. The rest were analized with X2 / AC-T: Adriamicin/Cyclophosphamide - Paclitaxel, EC-T: Epirrubicin/Cyclophosphamide - Paclitaxel, FAC-T: Fluorouracil/Cyclophosphamide-Paclitaxel
DISCUSSION: This study shows that normal weight and IV TZ is significantly associated with the risk of cardiotoxicity. The observation of our pt will continue to observe this phenomenon in detail.
Citation Format: Herrera-Martínez M, Miranda-Aguirre PA, Cota-Apodaca LA, Martínez-Bustos V, Carbajal-Saldaña B, Deneken-Hernandez ZC, Díaz-Romero C, Namba-Bando MdMY, Dominguez-Reyes CA, Tenorio-Torres JA, Villegas-Carlos F, Crocco-Quiros B. Risk factors for trastuzumab cardiotoxicity in a cohort of Mexican population [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-12-16.
