Routine Cardiac Evaluation in Patients With Early-Stage Breast Cancer Before Adjuvant Chemotherapy

Jeyakumar, Alwin; DiPenta, Jillian; Snow, Stephanie; Rayson, Daniel; Thompson, Kara; Theriault, Chris; Younis, Tallal

doi:10.1016/j.clbc.2011.07.006

Cited by 24 publications

(24 citation statements)

References 11 publications

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“…While guidelines exist for frequency of LVEF assessment for trastuzumab therapy, the evidence base for timing is sparse, and our findings suggest more frequent assessment of LVEF in the highest‐risk patients may be potentially warranted. A strategy of selective LVEF assessment is also consistent with a previous study of early‐stage breast cancer that found that routine LVEF screening did not influence treatment decisions for women less than 65 years of age without cardiac risk factors . The study's implication that LVEF screening is unlikely to alter treatment decisions for low‐risk patients, suggests that the converse may also be the case where more frequent LVEF screening would have clinical utility for individuals at increased risk.…”

Section: Discussionsupporting

confidence: 83%

Risk Prediction Model for Heart Failure and Cardiomyopathy After Adjuvant Trastuzumab Therapy for Breast Cancer

Ezaz

Long

Gross

et al. 2014

JAHA

223

182

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BackgroundAdjuvant trastuzumab improves survival for women with human epidermal growth factor receptor 2‐positive breast cancer, but increases risk for heart failure (HF) and cardiomyopathy (CM). However, clinical trials may underestimate HF/CM risk because they enroll younger subjects with fewer cardiac risk factors. We sought to develop a clinical risk score that identifies older women with breast cancer who are at higher risk of HF or CM after trastuzumab.Methods and ResultsUsing the Surveillance, Epidemiology and End Results (SEER)‐Medicare database, we identified women with breast cancer who received adjuvant trastuzumab. Using a split‐sample design, we used a proportional hazards model to identify candidate predictors of HF/CM in a derivation cohort. A risk score was constructed using regression coefficients, and HF/CM rates were calculated in the validation cohort. The sample consisted of 1664 older women (mean age 73.6 years) with 3‐year HF/CM rate of 19.1%. A risk score consisting of age, adjuvant chemotherapy, coronary artery disease, atrial fibrillation or flutter, diabetes mellitus, hypertension, and renal failure was able to classify HF/CM risk into low (0 to 3 points), medium (4 to 5 points), and high (≥6 points) risk strata with 3‐year rates of 16.2%, 26.0%, and 39.5%, respectively.ConclusionsA 7‐factor risk score was able to stratify 3‐year risk of HF/CM after trastuzumab between the lowest and highest risk groups by more than 2‐fold in a Medicare population. These findings will inform future research aimed at further developing a clinical risk score for HF/CM for breast cancer patients of all ages.

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Section: Discussionsupporting

confidence: 83%

Risk Prediction Model for Heart Failure and Cardiomyopathy After Adjuvant Trastuzumab Therapy for Breast Cancer

Ezaz

Long

Gross

et al. 2014

JAHA

223

182

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“…No modifications to treatment strategies were made because of LVEF findings. Additionally, Jeyakumar et al further confirmed in a population-based study of 238 breast cancer patients that, of the 198 patients who underwent baseline RVG screening, five patients (2.5%) had abnormal LVEF, ranging from 35% to 47% [9]. These findings resulted in change to nonanthracycline-based chemotherapy in 3 patients and no chemotherapy in 1 patient.…”

Section: Discussionsupporting

confidence: 48%

“…Limited prior research suggests that ECHOs and RVGs infrequently reveal clinically significant results that affect oncology treatment plans in this population [8][9][10][11]. In one study of 198 adults, RVGs were conducted in 80% of breast cancer patients undergoing adjuvant chemotherapy, with only 2.5% of RVGs indicating cardiac abnormalities, all in smokers [9].…”

Section: Introductionmentioning

confidence: 99%

“…In one study of 198 adults, RVGs were conducted in 80% of breast cancer patients undergoing adjuvant chemotherapy, with only 2.5% of RVGs indicating cardiac abnormalities, all in smokers [9]. Baseline ECHO results and potential effects of screening on treatment planning in patients undergoing trastuzumab therapy have not yet been studied.…”

Section: Introductionmentioning

confidence: 99%

“…Because of the noninvasive nature and broad availability of these exams, they are widely used for cardiac screening before chemotherapy [3]. Studies have estimated that between 60% and 80% of patients receive baseline cardiac evaluation with RVGs before chemotherapy, suggesting variation in implementation of the ACC and AHA recommendation [8,9].…”

Section: Introductionmentioning

confidence: 99%

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Evaluating the Utility of Baseline Cardiac Function Screening in Early-Stage Breast Cancer Treatment

et al. 2016

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Background. Cardiotoxicity can be a complication of anthracycline-or trastuzumab-based therapy for breast cancer patients. Screening echocardiograms (ECHOs) and radionuclide ventriculograms (RVGs) are often performed before administration of these agents to evaluate cardiac function. Limited evidence for the clinical utility of these screening tests is available. Methods. Early-stage breast cancer patients diagnosed from 2006 to 2011 (n 5 1,067) with baseline ECHOs/RVGs were identified in a single institution prospective registry. Medical record review was performed to obtain pre-and post-ECHO/ RVG treatment plans, baseline ECHO/RVG results, cardiac risk factors, and cardiac events. Patients with cardiac history were excluded. ECHO/RVG abnormalities were defined as ejection fraction (EF) ,55%, valvular disease, left ventricular hypertrophy, and diastolic dysfunction. Cardiac events were defined as heart failure, myocardial infarction, arrhythmia, valvular disease, or angina during or after chemotherapy.

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Cardiovascular risk assessment in oncological clinical trials: is there a role for centralized events adjudication?

Vaduganathan

Prasad

2015

European J of Heart Fail

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Routine Cardiac Evaluation in Patients With Early-Stage Breast Cancer Before Adjuvant Chemotherapy

Cited by 24 publications

References 11 publications

Risk Prediction Model for Heart Failure and Cardiomyopathy After Adjuvant Trastuzumab Therapy for Breast Cancer

Risk Prediction Model for Heart Failure and Cardiomyopathy After Adjuvant Trastuzumab Therapy for Breast Cancer

Evaluating the Utility of Baseline Cardiac Function Screening in Early-Stage Breast Cancer Treatment

Cardiovascular risk assessment in oncological clinical trials: is there a role for centralized events adjudication?

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