Evaluation of Cardiotoxicity in HER-2-Positive Breast Cancer Patients Treated With Radiation Therapy and Trastuzumab

Bachir, Bachir; Anouti, Sirine; Jaoude, Joseph Abi; Kayali, Majd; Tfayli, Arafat; Azambuja, Evandro de; Poortmans, Philip; Zeidan, Youssef H.

doi:10.1016/j.ijrobp.2021.12.159

Cited by 9 publications

(6 citation statements)

References 44 publications

(84 reference statements)

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“…Previous studies indicated that cardiac radiation doses were associated with subclinical LV dysfunction evaluated by LV GLS. Some studies also showed through 40 patients treated for left breast cancer, that for a mean heart dose of 1.3–2.5Gy, there was no correlation between GLS and mean heart dose 34 . In our study, there no difference in radiation history among the no CTR‐CVT, CTR‐CVT, and late‐onset CTR‐CVT group.…”

Section: Discussionsupporting

confidence: 50%

“…Some studies also showed through 40 patients treated for left breast cancer, that for a mean heart dose of 1.3-2.5Gy, there was no correlation between GLS and mean heart dose. 34 In our study, there no difference in radiation history among the no CTR-CVT, CTR-CVT, and lateonset CTR-CVT group. However, there was a significant difference in the history of left chest radiation exposure between the early-onset CTR-CVT group and the nonearly-onset CTR-CVT group.…”

Section: Univariate Logistic Regression Analyses Multivariate Logisti...contrasting

confidence: 44%

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Global longitudinal strain at 3 months after therapy can predict late cardiotoxicity in breast cancer

Liu

Qin

et al. 2023

Cancer Medicine

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Background Cancer therapy‐related cardiovascular toxicity (CTR‐CVT) is a major contributor to poor prognosis in breast cancer (BC) patients undergoing chemotherapy. Left ventricular global longitudinal strain (LV GLS) has predictive value for CTR‐CVT, while few researchers take into account late‐onset CTR‐CVT. This study sought to provide a guide for the prediction of late‐onset CTR‐CVT in primary BC over the 2 years follow‐up via strain and contrast‐enhanced echocardiography. Methods Anthracycline and anthracycline + targeted medication groups were created from 111 patients with stage I–III primary BC who were prospectively included. The left ventricular diastolic function, LV global long‐axis strain (GLS); left ventricular ejection fraction by contrast‐enhanced echocardiography (c‐LVEF), and electrocardiograms were collected at baseline, 3, 6, 12, and 24 months after the start of cancer treatment. The high‐sensitivity troponin‐T and NT‐pro BNP at baseline and 3 months after chemotherapy were measured. Results (1) LV GLS decreased in BC patients over time. (2) After 12 months' follow‐up, the LV GLS in the anthracycline+ targeted group was lower than in the anthracycline group. After 24 months' follow‐up, the GLS and c‐LVEF in the anthracycline + targeted group declined while the E/e’ increased. (3) Decreased LVEF (56%) and arrhythmia (38%) are the common causes of CTR‐CVT. Lower LVEF was a major factor in late‐onset CTR‐CVT. (4) Combination of LV GLS and c‐LVEF at 3 months were used as predictors for CTR‐CVT and exhibited a higher AUC than either one alone (AUC = 0.929, 95% CI: 0.863–0.970). LV GLS at 3 months can predict the late‐onset CTR‐CVT (AUC = 0.745, p < 0.001), and the cut‐off is 20.32%. Conclusions As time went on, the systolic and diastolic dysfunction of BC patients get worsened. The combination of LV GLS and c‐LVEF is better in the prediction of CTR‐CVT. Only the LV GLS at 3 months can predict the late‐onset CTR‐CVT.

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Section: Discussionsupporting

confidence: 50%

Section: Univariate Logistic Regression Analyses Multivariate Logisti...contrasting

confidence: 44%

Global longitudinal strain at 3 months after therapy can predict late cardiotoxicity in breast cancer

Liu

Qin

et al. 2023

Cancer Medicine

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“…The initiation of a subclinical drop in EF after the completion of RT, as well as the consistent trend of EF decrease throughout the entire multimodal, non-surgical treatment period, indicates a pattern that is linked to reductions of more than 10% in EF (see Figure 6 ). Results of the HERA trial [ 63 ] show that a decrease in EF of more than 10% was reported in 9.18% of patients with left breast cancer who received RT, 8.99% of patients with right breast cancer who received RT, and 8.80% of patients who did not undergo RT. However, there was no statistically significant difference between these 3 groups ( P =0.073) [ 63 ].…”

Section: Discussionmentioning

confidence: 99%

“…Results of the HERA trial [ 63 ] show that a decrease in EF of more than 10% was reported in 9.18% of patients with left breast cancer who received RT, 8.99% of patients with right breast cancer who received RT, and 8.80% of patients who did not undergo RT. However, there was no statistically significant difference between these 3 groups ( P =0.073) [ 63 ]. Our study shows that these reductions are typically irreversible and signify a significant deterioration in cardiac mechanical function.…”

Section: Discussionmentioning

confidence: 99%

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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“…[37][38][39] Prospective studies where trastuzumab might be given with radiotherapy have yielded similar results. [40][41][42][43] In the ATEMPT trial, concomitant administration of trastuzumab with postoperative whole-breast irradiation showed a low risk of pneumonitis (approximately 1% in both study groups) and generally low skin toxicity (no grade 3 or worse toxic effects in the trastuzumab group). 42 Analysis of cardiac function in the HERA trial, where trastuzumab was administered concomitantly with leftsided radiotherapy (n=1270), right-sided radiotherapy (n=1271), or no radiotherapy (n=780), revealed that radiotherapy did not significantly affect left ventricular ejection fraction or cardiovascular events at a median follow-up of 11 years.…”

Section: Anti-her2 Drugs (Non-antibody-drug Conjugates) and Radiotherapymentioning

confidence: 99%

International multidisciplinary consensus on the integration of radiotherapy with new systemic treatments for breast cancer: European Society for Radiotherapy and Oncology (ESTRO)-endorsed recommendations

Meattini,

Becherini,

Caini

et al. 2024

The Lancet Oncology

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Evaluation of Cardiotoxicity in HER-2-Positive Breast Cancer Patients Treated With Radiation Therapy and Trastuzumab

Cited by 9 publications

References 44 publications

Global longitudinal strain at 3 months after therapy can predict late cardiotoxicity in breast cancer

Global longitudinal strain at 3 months after therapy can predict late cardiotoxicity in breast cancer

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

International multidisciplinary consensus on the integration of radiotherapy with new systemic treatments for breast cancer: European Society for Radiotherapy and Oncology (ESTRO)-endorsed recommendations

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