Heart to Heart: Excess Cardiac Risk between Photon and Proton Radiation in the Treatment of Breast Cancer

526 Background: Z1041 randomized women with HER2+ operable breast cancer to: FEC → P+T (Arm 1) or P+T → FEC+T (Arm 2). Treatment administered as 5-FU 500 mg/m2, epirubicin 75 mg/m2 and cyclophosphamide 500 mg/m2 day 1 of a 21-day cycle x 4; paclitaxel 80 mg/m2weekly x 12 and T 4 mg/kg once then 2 mg/kg weekly x 11. T was to continue q3 weeks post-op for 40 weeks. A secondary aim was to examine the cardiotoxicity (CE). Methods: Ejection fraction (EF) was measured at baseline (BL), between regimens (wk 12), prior to surgery (wk 24) and PRN. Eligibility: BL EF ≥ 55%. CEs included decline in EF of > 15%, or >10% points to a value < LLN. Reversibility was adjudicated by blinded investigators as reversible (R: recovery of EF to ≤ 5% below BL), partially reversible (PR: recovery of > 10% points from nadir, but ≤ 5% points below BL), indeterminate (IN: no additional EF data), or irreversible (IRR:follow-up EF studies showed no improvement). Results: Of the 280 patients (Arm 1: 138) who began treatment, 15 pts (Arm 1: 10; Arm 2: 5) did not receive T. The number of weeks of T was 13 (range: 1-18) in Arm 1 and 24 (range: 1-31) in Arm 2. Changes in EF and severe treatment related cardiac toxicities prior to surgery (sx) are tabled below. There were 271 pts (Arm 1: 131) who had post-BL EFs. Prior to sx, there were 11 CE (8.3%) in Arm 1 and 13 CE (9.2%) in Arm 2. CEs were R in 12 pts (Arm 1: 5; Arm 2: 7); PR in 6 pts (Arm 1: 4; Arm 2: 2); IN in 4 pts (Arm 1: 2; Arm 2: 3) and IRR in 1 Arm 2 pt. Conclusions: The number of CE events in arms 1 and 2 showed no significant difference; greater scatter was observed in arm 2 patients. While concern for late cardiac events makes ongoing cardiac surveillance prudent due to A, concomitant use of A and T appear to not be associated with increased cardiac risk. Clinical trial information: NCT00513292. [Table: see text]

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N-terminal pro-brain natriuretic peptide levels after receipt of anthracycline for breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e24103 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e24103-e24103

Author(s):

Shruti R Patel ◽

Joerg Herrmann ◽

Robert A. Vierkant ◽

Janet E. Olson ◽

Fergus Couch ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Brain Natriuretic Peptide ◽

Natriuretic Peptide ◽

Cardiac Risk ◽

The United States ◽

Linear Regression Models ◽

Cardiac Risk Factors ◽

Anthracycline Therapy ◽

Er Status

e24103 Background: Many of the 200,000 patients diagnosed with breast cancer (BC) annually in the United States receive anthracycline-based therapy, increasing their risk of future congestive heart failure. N-terminal brain natriuretic peptide (NT-proBNP) has been used as a biomarker of asymptomatic cardiac dysfunction in the general population and is of interest to identify patients who might benefit from echocardiography during survivorship. This study aimed to assess how age, baseline comorbidities, and time since BC diagnosis impact NT-proBNP levels after anthracycline-based chemotherapy. Methods: This retrospective study, using samples collected in our ongoing prospective Mayo Clinic Breast Disease Registry, included 20 survivors of non-metastatic BC patients per year for each of the first 5 years after anthracycline-based chemotherapy (n=100 total). NT-pro-BNP levels were assessed using a Roche immunoassay. Cardiac risk factors were obtained by chart review. Multivariable linear regression models assessed associations between NT-proBNP values and these independent variables: baseline cardiac risk factors (including hypertension, hyperlipidemia, obesity, diabetes mellitus, and smoking), tumor ER status (surrogate for possible endocrine therapy), time between diagnosis and serum collection, T and N status, use of trastuzumab, and age. Results: The mean age at the time of BC diagnosis was 52.2 (SD 9.8). 13% of tumors were human epidermal growth factor receptor (HER2)-positive and 71% were estrogen receptor (ER) positive. NT-proBNP was elevated in 34%. Mean NT-BNP level was higher (p=0.047) for those in years 4-5 (158 pg/mL) compared to those in years 1-3 (106 pg/mL) (See Table.) Models revealed years from diagnosis to serum draw (p=0.026), older age (p=0.006), more cardiac risk factors (p=0.064), and N2-3 (p=0.001) were associated with elevated NT-pro-BNP level. Use of trastuzumab, ER status, and tumor size were not associated with NT-proBNP. Conclusions: NT-proBNP is elevated in 1/3 of survivors who received anthracycline therapy for BC. As expected, cardiac risk factors and advancing age are associated with higher NT-proBNP. NT-proBNP values >300 were only found in patients who were 4-5 years after diagnosis. Additional research will be needed to further define the diagnostic and prognostic merit of NT-proBNP in survivors after receipt of anthracycline therapy. [Table: see text]

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Long-term irreversible trastuzumab-induced cardiotoxicity for metastatic breast cancer in a patient without cardiac risk factors

Oxford Medical Case Reports ◽

10.1093/omcr/omx038 ◽

2017 ◽

Vol 2017 (7) ◽

Cited By ~ 4

Author(s):

Satoru Tanaka ◽

Ayana Ikari ◽

Toshikatsu Nitta ◽

Tetsuya Horiuchi

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Metastatic Breast Cancer ◽

Metastatic Breast ◽

Cardiac Risk ◽

Cardiac Risk Factors

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Breast cancer radiotherapy and cardiac risk

Oncology Reviews ◽

10.4081/oncol.2010.137 ◽

2011 ◽

Vol 4 (3) ◽

pp. 137

Author(s):

Anusheel Munshi ◽

Kaustav Talapatra ◽

Debanarayan Dutta

Keyword(s):

Breast Cancer ◽

Survival Benefit ◽

Medical Oncology ◽

Breast Conservation ◽

Cardiac Risk ◽

Cancer Radiotherapy ◽

Breast Cancer Radiotherapy ◽

Overall Survival Benefit ◽

Multimodality Approach ◽

Developed World

Breast cancer is the leading cause of morbidity and mortality in women in the developed world and its incidence in the developing world is on the rise. Management of breast cancer requires a multimodality approach and an integration of the services of surgery, radiation, and medical oncology. Radiotherapy after mastectomy or breast conservation leads to reduction in local recurrence by two-thirds. Recent trials and metaanalyses have also demonstrated overall survival benefit with radiotherapy. Of late, however, there has been concern regarding side effects of radiotherapy in breast cancer. Among these the cardiac risk has been particularly been of concern. This review discusses the etiology, manifestations, and evidence in relation to implication of breast cancer radiotherapy in cardiac adverse effects.

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