Evaluation of weekly epirubicin-paclitaxel (EP) cardiotoxicity with serum troponin-t and myoglobin and echocardiography in advanced breast cancer (ABC)

Nisticò, Cecilia; Bria, Emilio; Carpino, Armando; Vitelli, Gaetano; Cuppone, Federica; Izzo, F.; Tropea, Francesco; Vanni, Barbara; Astorre, P.; Terzoli, E.

doi:10.1200/jco.2004.22.90140.775

Cited by 1 publication

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“…This finding contradicts previous research that reported no acute cardiac toxicity (such as alterations in EF, troponin levels, or myoglobin drops) during the immediate weeks following CHT [ 54 ]. The absence of these factors, coupled with the presence of inflammatory conditions, is associated with an almost 3-fold increase in the time interval for recording such events, primarily in a subclinical manner.…”

Section: Discussioncontrasting

confidence: 99%

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Early Echocardiography and ECG Changes Following Radiotherapy in Patients with Stage II-III HER2-Positive Breast Cancer Treated with Anthracycline-Based Chemotherapy with or without Trastuzumab-Based Therapy

Toma,

Anca,

Trifănescu

et al. 2023

Med Sci Monit

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Background Cardiotoxicity from radiotherapy and anti-cancer therapies have been reported in patients with breast cancer. This study aimed to investigate the early echocardiography and ECG changes following radiotherapy in 68 patients ages 30–78 years with stages II–III HER2-positive breast cancer treated with anthracycline-based chemotherapy with or without trastuzumab-based therapy from 2015 to 2021. Material/Methods We analyzed data of 68 breast cancer patients aged 30–78 years, predominantly in AJCC stages II–III (61) and HER2-positive (58), treated and monitored from 2015 to 2021. Cardiac function was assessed using echo- and electrocardiography. We employed univariate logistic models to gauge associations between pre-existing cardiac conditions, treatment modalities, and changes in cardiac function. Results A decrease in the left ventricle ejection fraction (EF) by >5% was associated with heart doses >49.3 Gy and with maximum and average doses to the left anterior descending artery (LAD) exceeding 46.9 Gy and 32.7 Gy, respectively. An EF drop of ≥10% was correlated with anti-HER2 therapy, pre-existing ECG changes, and the onset of conditions in the left ventricle, major vessels, and valves. Conditions were exacerbated in patients with prior echocardiographic abnormalities, while some emerged concurrent with the EF decline. Conclusions This research emphasizes the importance of personalized heart monitoring and care for breast cancer patients undergoing multimodal therapies. Significant and potentially irreversible EF declines can result from radiation and anti-HER2 treatments.

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Section: Discussioncontrasting

confidence: 99%

“…A decrease in LV systolic strain after anthracycline treatment may indicate early myocardial impairment [ 58 ]. Myocardial damage of varying degrees, which can be inferred from an increase in troponin or myoglobin levels [ 54 ], is the underlying mechanism for EF reduction, particularly in patients who have received both ACs and RT.…”

Section: Discussionmentioning

confidence: 99%