Anthracycline-Induced Cardiotoxicity in Breast Cancer Patients: A Five-Year Retrospective Study in 10 Centers

Abstract

Background: Cardiotoxicity as a result of anthracycline chemotherapy has been linked to increased morbidity and mortality in breast cancer patients. There is a need for early detection through risk factor identification. To date, no large multicenter study has been conducted to describe the incidence, risk factors and clinical and demographic profiles of breast cancer patients with anthracycline-induced cardiotoxicity (AIC) in the Philippines.Methods: This was a nationwide multicenter retrospective cohort study among adult breast cancer patients who underwent anthracycline chemotherapy from 2015 to 2020 in 10 sites in the Philippines. Baseline characteristics and possible risk factors for AIC were re-trieved from medical records and cancer registries. AIC was defined as a reduction of left ventricular ejection fraction (LVEF) by > 10% from baseline to a value of < 53% or the development of overt left ventricular systolic dysfunction or heart failure (HF). Odds ratios from logistic regression were computed to determine risk factors associated with AIC using STATA-15.0 software. Results:Out of 341 patients included, 33 had AIC, accounting for an incidence of 9.68%. Nine patients (2.6%) had clinical HF. AIC patients had a mean age of 53.91 ± 10.84 years. Breast cancer AIC patients were significantly older and had lower body mass index (BMI) than those without AIC. AIC patients had significantly more comorbidities, especially hypertension and atrial fibrillation. Multivariate analysis showed that patients with any preexisting comorbidity are approximately 12.37 times as likely to have AIC, while those with concurrent chemotherapy are 0.07 times or 93% less likely to have AIC. Conclusion:Among adult breast cancer patients undergoing anthracycline chemotherapy, we determined a high incidence of cardiotoxicity at 9.68%. Having preexisting comorbidities gave patients 12 times increased odds of developing anthracycline cardiotoxicity. The presence of concurrent non-anthracycline chemotherapy showed an inverse association with the development of AIC which we attribute largely to patient selection in a retrospective study. The significantly higher propensity for AIC development in patients with preexisting comorbidities may warrant closer monitoring and control of patient comorbidities such as hypertension among patients undergoing anthracycline chemotherapy.

Examining hypertension risk among Black and White breast cancer survivors

“…Studies have demonstrated a higher risk of CTRCD among women who have hypertension when receiving treatment with potentially cardiotoxic treatment for breast cancer when compared to women who do not have hypertension. [6][7][8] What has not been fully characterized are the risk factors for hypertension, beyond cardiotoxic treatment. Studies in women without breast cancer have identified risk factors for hypertension to include family history, obesity, and older age.…”

Efficacy and harms associated with beta-blockers for cardiotoxicity in cancer patients undergoing chemotherapy: a systematic review and meta-analysis.

“…Some risk factors associated with anthracycline-induced cardiotoxicity include cumulative dose, female sex, and pre-existing heart conditions such as arterial hypertension [3]. About 10% of breast cancer patients undergoing anthracycline chemotherapy develop cardiotoxicity and about 20% of long-term lymphoma survivors treated with anthracyclines have asymptomatic cardiac dysfunction [5][6][7].…”

Long Term Follow-Up of Cardiotoxicity in Breast Cancer Treatment: A Case Report

“…In a study of over 43,000 patients with breast cancer, followed over a median of 53 months, anthracycline chemotherapy was associated with an adjusted hazard risk of 1.26 for the development of heart failure (HF) in women aged 66 -70 years [4]. On the other hand, after cancer therapy, the St. Jude Lifetime Cohort Study showed that the prevalence of cardiac dysfunction, defined by decreased GLS, was 31.8% at a median interval of 23 years from diagnosis in long-term adult survivors of childhood cancers treated with anthracyclines, chest radiation, or both [2].…”