Outcome analysis of breast cancer patients treated with cardiotoxic agents in the community setting: A single-institution experience.
213 Background: Anthracyclines and anti-Her-2 targeted therapy are commonly used effective breast cancer treatments. They are known to decrease Left Ventricular Ejection Fraction (LVEF), which may increase patients’ morbidity and mortality. There is currently no consensus on post treatment cardiac follow-up. Recent observations suggested that ACEI and B blocker drugs could have cardioprotective effects. We conducted a retrospective study to assess patients’ cardiac outcome using post-treatment LVEF follow-up and effect of ACEI and B blocker on cardiac outcome for breast cancer patients who received cardiotoxic agents in our institution. Methods: We reviewed 155 charts of non-metastatic breast cancer patients between 2000-2008, who received anthracyclines and/or anti-Her-2 targeted therapy. Patients were stratified into groups A (anthracycline), B (trastuzumab) and C (anthracycline+trastuzumab). Results: Patients’ median age was 52.5 years. Six patients had coronary artery disease and 45 received radiation to the left breast. After a median follow-up of 93 months, only 3 of 155 (2%) patients developed symptoms of congestive heart failure. One hundred twenty patients had pre-treatment LVEF evaluation, while only 31 patients had pre and post LVEF evaluation. Mean LVEF difference was -7.89, - 9.01, -9 and -6.08 for all patients, group A, group B and group C, respectively. Thirty patients were on ACEI, 7 of them had LVEF follow-up with mean difference of -6.86. Thirty patients were on B blocker, 7 of them had LVEF follow-up with mean difference of -15. Because of the small size of the groups who had LVEF follow-up, no statistical difference can be detected. Conclusions: Our patient population showed very low incidence of clinically significant cardiac events in relation to anthracycline and anti-her-2 directed therapy after a median follow-up of 93 months. However, further follow is required to assess cardiac outcome that may affect quality of life and survival later in life. In this regard, our institution is establishing a dedicated cardio-oncology service to closely monitor patients who have been treated with cardiotoxic agents and provide early cardiac management if needed.