scholarly journals CORRELATION BETWEEN CHANGES OF NT-PRO BNP AND HS-TROPONIN I LEVEL WITH CARDIOTOXICITY IN LOCALLY ADVANCED BREAST CANCER AFTER THREE CYCLES OF NEOADJUVANT CAF CHEMOTHERAPY

2019 ◽  
Vol 26 (1) ◽  
pp. 71
Author(s):  
Cicilia Indriaty ◽  
Leonita Anniwati ◽  
J.Nugroho Eko Putranto ◽  
Desak Gede Agung Suprabawati
Keyword(s):  
Breast Cancer ◽  
Advanced Breast Cancer ◽  
Troponin I ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Left Ventricular ◽  
Advanced Breast ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Before And After

Chemotherapy with cyclophosphamide, adriamycin, and fluorouracil (CAF) regiment in patients with locally advanced breast cancer have a risk of cardiotoxicity. Cardiotoxicity examination standards using left ventricular ejection fraction (LVEF) by echocardiography are considered insensitive for detection of subclinical ventricular dysfunction. NT-pro BNP and Hs-Troponin I (hs-TnI) as cardiac biomarkers are expected to help detect early cardiotoxicity. This study intended to analyze the correlation between changes of NT-pro BNP and hs-TnI levels with cardiotoxicity in breast cancer after three cycles of chemotherapy.This was a cross-sectional observational study, conducted at the Dr. Soetomo General Hospital Surabaya. The subjects consisted of 23 breast cancer patients who underwent chemotherapy with CAF regiment. NT-proBNP and hs-TnI examination used CLIA methods (Immulite 1000, ADVIA Centaur TnI-Ultra). Cardiotoxicity based on decreased  LVEF to more than 10% of the initial LVEF value using echocardiography. Significant increases in NT pro BNP and hs-TnI levels were obtained before and after treatment (p=0.000, p=0.002). A significant decrease in LVEF was obtained before and after treatment (p=0.000), but only 2 patients (8.7%) showed cardiotoxicity. There was no correlation between changes in NT-pro BNP and hs-TnI levels with changes in LVEF before and after chemotherapy (p=0.666 and r=0.095; p=0.254 and r=-0.28). There was no correlation between changes in NT-pro BNP and hs-TnI levels with cardiotoxicity, which was assessed based on LVEF reduction, in locally advanced breast cancer after three-cycles of chemotherapy with CAF regiment.

Neoadjuvant trastuzumab in locally advanced breast cancer (NOAH): Antitumour and safety analysis

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 532-532 ◽  
Author(s):  
L. Gianni ◽  
V. Semiglazov ◽  
G. M. Manikhas ◽  
W. Eiermann ◽  
A. Lluch ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Advanced Breast Cancer ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Left Ventricular ◽  
Advanced Breast ◽  
Phase Iii ◽  
Left Ventricular Ejection ◽  
Her2 Positive ◽  
Ventricular Ejection Fraction

532 Background: NOAH (NeOAdjuvant Herceptin) is a Phase III trial of neoadjuvant trastuzumab; H) in combination with chemotherapy in patients (pts) with HER2-positive locally advanced breast cancer (LABC). Methods: 228 pts with centrally confirmed HER2-positive (IHC 3+ or FISH+) LABC received 3 cycles of doxorubicin-paclitaxel (AT: A 60 mg/m2, T 150 mg/m2 q3w), 4 cycles of T (175 mg/m2 q3w) and 3 cycles of cyclophosphamide/methotrexate/5-fluorouracil (CMF: C 600 mg/m2, M 40 mg/m2, F 600 mg/m2 q4w) on days 1 and 8, with (n=115) or without (n=113) concomitant H (8 mg/kg loading dose then 6 mg/kg q3w for 1 year) before surgery. Pts with HER2- negative disease (IHC 0/1+; n=99) were treated in parallel with AT/T/CMF. The primary end point was event-free survival (EFS); secondary end points included overall response rate (ORR), pathological complete response (pCR) rate and safety. Results: Baseline characteristics were well balanced for randomised pts. Median tumour size was 5.5 cm (range 1.5–20.0). Inflammatory breast cancer (IBC) was present in 40% of HER2-positive vs 14% of HER2-negative tumours, while 35% vs 65%, respectively, were hormone receptor positive. Left ventricular ejection fraction (LVEF) at baseline was similar in all 3 groups. Adding H to AT/T/CMF improved ORR (81% vs 73%; p=0.18) and significantly increased pCR rate (43% vs 23%; p=0.002). This response pattern was also seen in IBC pts. ORR (66%) and pCR rate (17%) for pts with HER2-negative disease were similar to pt responses in the HER2-positive group who did not receive H. The most common serious adverse event was febrile neutropenia (8% with H vs 4% without). Only 11% of pts receiving H had absolute LVEF decreases of =10% and 1 pt treated with H experienced a cardiac event with an LVEF value of <45%. One pt with HER2-negative disease died after surgery due to pulmonary embolism. Conclusions: Neoadjuvant H plus AT/CMF-containing chemotherapy significantly improved the pCR rate of LABC vs chemotherapy alone. Treatment was well tolerated with acceptable cardiac safety. Follow-up is ongoing and EFS is maturing. [Table: see text]

scholarly journals High Sensitive Troponin I and Extended Range C-Reactive Protein as Markers to Predict Cardiotoxicity in Locally Advanced Breast Cancer with Neoadjuvant CAF (Cyclophoshpamide, Adriamycin/Doxorubicin, 5Fluorouracil) Therapy

2020 ◽  
Vol 56 (2) ◽  
pp. 91
Author(s):  
Yusfik Helmi Hidayat ◽  
Hantoro Ishardyanto ◽  
Leonita Anniwati
Keyword(s):  
Breast Cancer ◽  
Advanced Breast Cancer ◽  
Troponin I ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Advanced Breast ◽  
Breast Cancer Patients ◽  
Reactive Protein ◽  
Before And After ◽  
Chemotherapy Cardiotoxicity

The limitation of echocardiography to measure chemotherapy cardiotoxicity at left locally advanced breast cancer with large ulcer is still serious problem. HsTnI and erCRP are biomarkers to detect cardiotoxicity that are cheap, easy to examine and available at Dr.Soetomo Hospital Surabaya. This study was to compare HsTnI, erCRP and echocardiography as cardiotoxicity predictors in locally advanced breast cancer with neoadjuvant CAF therapy. This study used one group pretest and posttest design among 23 locally advanced breast cancer patients. All patients underwent echocardiography, HsTnI, and erCRP examinations before and after 3 times chemotherapy and compared. The average age was 49.78±8.7. Statistically significant decrease in LVEF was found after treatment (67.98%±4.06 and 64.07%±3.53, p=0.000). HsTnI was significantly increased after treatment (0.007 µg/mL±0.004 and 0.043 µg/mL±0.051 p=0.000). erCRP was significantly decreased after treatment (1.043mg/dL±0.913 and 0.573mg/dL±0.444 p=0.044). Decreased LVEF and increased HsTnI was compared by its cardiotoxic cut-off. HsTnI was significantly better and faster to detect cardiotoxicity (0.033±0.051 p=0.002). In conclusion, strong correlation is present in the detection of cardiotoxicity between HsTnI and LVEF. HsTnI is faster than echocardiography, and could be alternative diagnostic to detect early cardiotoxicity.

A randomized comparison of single-agent doxorubicin and epirubicin as first-line cytotoxic therapy in advanced breast cancer.

1991 ◽  
Vol 9 (12) ◽  
pp. 2148-2152 ◽  
Author(s):  
D J Perez ◽  
V J Harvey ◽  
B A Robinson ◽  
C H Atkinson ◽  
P J Dady ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Advanced Breast Cancer ◽  
Cardiac Failure ◽  
Response Duration ◽  
Left Ventricular ◽  
Advanced Breast ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

One hundred forty-one patients with advanced breast cancer who had not received prior chemotherapy were randomly assigned to receive doxorubicin 60 mg/m2 or epirubicin 90 mg/m2 every 3 weeks. These doses were selected to produce equivalent toxicities. All patients were assessed for toxicity, and 138 patients were assessable for response. After a median of five treatment cycles, 47% (32 of 68) of doxorubicin-treated patients achieved a partial or complete response. Response duration and survival were 10 and 12 months for doxorubicin and 8 and 10 months for epirubicin, respectively. Noncardiac toxicities were similar for both drugs. Of 41 patients receiving doxorubicin who had serial left ventricular ejection fraction assessments, seven sustained a fall of 10% or more, and one patient developed congestive cardiac failure at a cumulative doxorubicin dose of 489 mg/m2. Of 39 patients receiving epirubicin who had serial cardiac assessments, five sustained left ventricular ejection fraction falls of 10% or more and two patients developed congestive cardiac failure at cumulative doses of 178 mg/m2 and 833 mg/m2. These data indicate that an epirubicin dose of 90 mg/m2 produces toxicity equivalent to doxorubicin 60 mg/m2 but does not improve response rates, response duration, or survival in advanced breast cancer.

Expression of BAG-1 and BcL-2 Proteins Before and After Neoadjuvant Chemotherapy of Locally Advanced Breast Cancer

2004 ◽  
Vol 22 (2) ◽  
pp. 248-256 ◽  
Author(s):  
Lajos Pusztai ◽  
Savitri Krishnamurti ◽  
Jorge Perez Cardona ◽  
Nour Sneige ◽  
Francisco J. Esteva ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Advanced Breast Cancer ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Advanced Breast ◽  
Before And After

scholarly journals The Effect of External Radiotherapy to the Left Ventricle Systolic Function in Locally Advanced Breast Cancer Patients

2021 ◽  
Vol 8 (11) ◽  
pp. 350-356
Author(s):  
Helmy Fahada ◽  
Desak Agung Suprabawati ◽  
Dyah Erawati
Keyword(s):  
Breast Cancer ◽  
Advanced Breast Cancer ◽  
Cancer Patients ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Left Ventricular ◽  
Advanced Breast ◽  
External Radiation ◽  
Breast Cancer Patients ◽  
Number Of Patients

Background: Locoregional management in breast cancer patients includes surgery and radiation. Radiation increases the risk of the decreasing of cardiac ventricular performance and known as cardiotoxicity. This study aims to analyze the relationship between radiation exposure in locally advanced breast cancer patients with the left ventricular systolic function. Methods: The subjects in this study were patients with locally advanced breast cancer who underwent external radiation therapy after surgery procedure at Dr. Soetomo General Hospital in January 2021 – April 2021. Examination of left ventricular performance parameters was carried out using an invasive method, the transthoracic echocardiography. The performance parameters examined were left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS). Results: A total of 45 patients were recruited in this study. Twenty-two patients (22/45; 48.9%) underwent radiation therapy from the left side and 23 patients (23/45; 51.1%) from the right side. After external radiation, the number of patients with left ventricular dilatation were increased. On the left side, there were 6 patients (6/22; 27.6%) who experienced dilatation compared to before radiation (3 patients), while on the right side of the body there were 8 patients (8/22; 34.8%) who experienced dilatation compared to before radiation (6 patients). There was an increase in the number of patients who experienced a decrease in EFT and EFB after radiation, although the association was not significant. Almost all patients experienced a decrease in GLS values ​​after radiation (44/45; 97.8%). Conclusion: There was an increase in the number of patients with left ventricular dilatation and decrease in EFT and EFB values after external radiation. Decreased GLS values ​​were found in almost all patients who underwent external radiation in this study. Keywords: Radiation, locally advanced breast cancer, LVID, ejection fraction, GLS.

scholarly journals Effects of Neoadjuvant Fluorouracyl-Adriamycin- Cytoxan (FAC) Chemotherapy Response to CD4 + Serum Levels In Breast Cancer

2018 ◽  
Vol 1 (1) ◽  
pp. 1-9
Author(s):  
Ade Permana ◽  
Benny Kusuma ◽  
Nur Qodir ◽  
Legiran
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Advanced Breast Cancer ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Advanced Breast ◽  
Chemotherapy Response ◽  
Breast Cancer Chemotherapy ◽  
Significant Difference ◽  
Before And After

Introduction. CD4+ T-helper has an important role in immune system modulation especially to maintain long-term anti tumor effect. CD4+ also serves to activate CD8+ for destroyed the tumor cells. It was expected there were role of immunity on tumor growth and response of breast cancer chemotherapy to CD4+ levels serum. Furthermore, this study was aimed to investigate the effects of neoadjuvant chemotherapy on CD4+ levels in patients with locally advanced breast cancer at General Hospital Dr. Mohammad Hoesin Palembang. Method. This study was a non-comparable clinical trial by looking at serum CD4+ levels in patients with locally advanced breast cancer before and after neoadjuvant chemotherapy.   Results. Of the 30 subjects the subject age ranged from 33-66 years with an average of 45 years. There were 17 patients with contraception history (56.7%), 13 patients with family history of breast cancer (43.3%). From this study, it was obtained 23 patients with good chemotherapy response (76.7%) and there were 7 patients who had poor chemotherapy response after neoadjuvan chemotherapy (23.3%). Paired t-test analysis showed that there was a significant difference in mean CD4+ count before and after neoadjuvan chemotherapy. At the CD4+ level before chemotherapy 775.55 had a sensitivity of 60% and a specificity of 57% (cut of point). While CD4+ levels after chemotherapy 470.85 with sensitivity of 60% and specificity of 57%.   Conclusion. CD4+ pre-chemotherapy examination had a sensitivity score of 60% and a specificity of 57% in predicting neoadjuvant chemotherapy response.    

Neratinib in combination with trastuzumab for the treatment of advanced breast cancer: A phase I/II study

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 1004-1004 ◽  
Author(s):  
R. Swaby ◽  
K. Blackwell ◽  
Z. Jiang ◽  
Y. Sun ◽  
V. Dieras ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Advanced Breast Cancer ◽  
Objective Response Rate ◽  
Response Rate ◽  
Objective Response ◽  
Left Ventricular ◽  
Advanced Breast ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Trastuzumab Therapy

1004 Background: Neratinib (HKI-272) is an orally administered irreversible pan-ErbB receptor tyrosine kinase inhibitor. In an ongoing phase II study, the preliminary objective response rate was 26% in patients with ErbB2+ advanced breast cancer with prior trastuzumab therapy. This study assessed the safety and preliminary efficacy of the combination of neratinib plus trastuzumab. Methods: Patients with advanced ErbB2+ breast cancer that progressed following trastuzumab therapy were enrolled. The primary endpoint was 16-week progression free survival rate (PFS). In part 1 (dose escalation), patients received neratinib 160 mg or 240 mg daily plus trastuzumab 4 mg/kg IV loading dose then 2 mg/kg weekly. In part 2, patients received weekly trastuzumab with neratinib 240 mg daily. Timed blood samples were collected for PK analyses. PK analysis is ongoing. Results: 45 patients (part 1 n = 8; part 2 n = 37) were enrolled (mean age 52 yr); 9 are active. In part 1, cohorts 1 and 2 were fully enrolled with 4 patients each. No dose limiting toxicities were observed. Most common AEs, any grade, were diarrhea (91%), nausea (51%), anorexia (40%), vomiting (38%), and asthenia (27%). Grade 3/4 AEs were diarrhea (13%), nausea (4%), vomiting (4%). Two patients receiving neratinib 240 mg reported AEs leading to withdrawal. No AEs of congestive heart failure and no significant drops of left ventricular ejection fraction were reported. Among 33 patients evaluable for efficacy, objective response rate was 27% (95% CI, 13% - 46%); 16-week PFS rate (for part 2) 47% (95% CI, 29% - 63%); median PFS was 19 weeks (95% CI 15 - 32 weeks). Conclusions: Neratinib plus trastuzumab was well tolerated with no significant or unexpected toxicities, and demonstrated clinical activity. [Table: see text]

Safety and activity of nonpegylated liposomal doxorubicin (nPLD) combined with oral metronomic cyclophosphamide (mC) as preoperative treatment for locally advanced breast cancer (BC) patients (pts).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e11546-e11546
Author(s):  
Daniele Andreis ◽  
Daniele Giulio Generali ◽  
Chiara Foroni ◽  
Letizia Bazzola ◽  
Mariarosa Cappelletti ◽  
...  
Keyword(s):  
Locally Advanced Breast Cancer ◽  
Objective Response ◽  
Locally Advanced ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Preoperative Treatment ◽  
Luminal A ◽  
Ventricular Ejection Fraction ◽  
Before And After ◽  
Cd31 Expression

e11546 Background: nPLD has the same clinical benefits but less toxicity than the traditional doxorubicin. It’s well reported mC produces anti-proliferative and anti-angiogenic effect in tumours. We conducted a retrospective study to evaluate the safety and activity of the association of nPLD and mC in pts with locally advanced BC. Methods: A total of 41 female pts with HER2-negative locally advanced BC unfit for standard chemotherapy received nPLD 25 mg/mq biweekly for eight courses along with mC 50 mg daily as primary systemic treatment. Toxicity and clinical-radiological response with Ki67 and CD31 expression were evaluated in tumour specimens obtained before and after treatment. Results: Pts characteristics included: median age 47.5 years; 31.7% Luminal A (LA), 56.1% Luminal B (LB), and 12.2% Triple Negative BC subtype classified by immunohistochemistry. The rate of breast-conserving surgery was 59.5%. All pts were evaluable for response. Objective response rate (ORR) was 58.5% (95% confidence interval, 42.1% to 73.7%), with 4 (9.7%) clinical complete responses (CR) and 20 (48.8%) partial responses. Sixteen pts (39.0%) achieved a stable disease and 1 pt progressed. One pt experienced a pathological CR. LA subtype was significantly associated with better ORR than others subtypes (p=0.049) and especially than LB (p=0.040). There was a borderline significant reduction of Ki67 expression after treatment (median, 15.5% to 9%; p=0.056), but no significant variation in CD31 expression (p=0.865). The majority of adverse events (AEs) were mild or moderate. Grade ≥3 AEs included neutropenia (12.2%), vomiting (4.9%) and hyperglycemia (2.44%). Temporary treatment suspension due to toxicity occurred in 8 (19.5%) pts; discontinuation was necessary in 1 pt. No symptoms were related to impairment of cardiac function. Mean left ventricular ejection fraction levels did not change substantially before and after treatment: 58.7% and 57.1%, respectively. Conclusions: The combination of nPLD and mC is well tolerated, with a promising activity as preoperative therapy in unfit pts with locally advanced BC.

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