scholarly journals Anthracyclines and Trastuzumab-induced Cardiotoxicity in Breast Cancer Patients: Testing a Clinical Risk Score in the First Cardio-Oncology Unit in Morocco

2021 ◽  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Risk Score ◽  
Clinical Risk Score ◽  
Breast Cancer Patients ◽  
Clinical Risk ◽  
Oncology Unit

Abstract 14206: Assessing a Clinical Risk Score and the Impact of Race in Breast Cancer Patients at Risk of Cardiotoxicity

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Zachary Brumberger ◽  
Mary Branch ◽  
Joseph Rigdon ◽  
Suji Vasu
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Risk Score ◽  
Significant Risk ◽  
Statistical Characteristics ◽  
Risk Scores ◽  
Clinical Risk Score ◽  
Breast Cancer Patients ◽  
Clinical Risk ◽  
The Impact

Introduction: Cardiotoxicity is a well-known risk in breast cancer patients treated with anthracyclines and trastuzumab. Ezaz et al. developed a clinical risk score (CRS) to risk stratify these patients. Despite evidence that African American (AA) race is a significant risk factor for cardiotoxicity, no study has assessed the impact of AA race on this CRS. Here we assess the discrimination ability of the Ezaz et al. CRS with the addition of AA race. Methods: This is a retrospective cohort utilizing a registry of 118 patients with stage I-IV breast cancer treated with anthracyclines and/or trastuzumab. Patients without baseline echocardiography data or with baseline LVEF < 50% were excluded. The CRS from Ezaz et al. consisting of age, adjuvant chemotherapy, coronary artery disease, atrial fibrillation or flutter, diabetes mellitus, hypertension, and renal failure was calculated with the addition of AA race. Cardiotoxicity was defined by an LVEF decline of ≥ 10% to LVEF < 53% from baseline. Results: In our 118 patient cohort, the mean age was 59 years, 23 (20%) AA patients, 65 (55%) patients considered low risk (scores of 0-3) and 53 (45%) considered moderate to high risk (scores ≥4). After a follow up of 3 months to 5 years, 14 (12%) patients developed cardiotoxicity. Table 1 lists the CRS changes in statistical characteristics and predictability with the addition of AA race. In comparing the models, the AUC c-statistic increased from 0.609 to 0.642 (95% CI 0.47-0.75, 95% CI 0.49-0.79 respectively; P value = 0.56) with the addition of AA race ( Figure 1 ). Conclusions: In this study, the Ezaz et al. CRS demonstrated improved discrimination and sensitivity with the addition of AA race. This study suggests AA race improves the predictive ability of the Ezaz et al. CRS. Given the limited size of our study, we promote that this should be hypothesis-driving and encourage further investigation on the path to develop an important risk stratification tool.

Immune-related gene based prognostic signature for the risk stratification analysis of breast cancer

2021 ◽  
Vol 16 ◽  
Author(s):  
Dongqing Su ◽  
Qianzi Lu ◽  
Yi Pan ◽  
Yao Yu ◽  
Shiyuan Wang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Regression Analysis ◽  
Cancer Patients ◽  
Risk Score ◽  
Cox Regression ◽  
Enrichment Analysis ◽  
Gene Set Enrichment Analysis ◽  
Breast Cancer Patients ◽  
Cox Regression Analysis ◽  
Score Model

Background: Breast cancer has plagued women for many years and caused many deaths around the world. Method: In this study, based on the weighted correlation network analysis, univariate Cox regression analysis and least absolute shrinkage and selection operator, 12 immune-related genes were selected to construct the risk score for breast cancer patients. The multivariable Cox regression analysis, gene set enrichment analysis and nomogram were also conducted in this study. Results: Good results were obtained in the survival analysis, enrichment analysis, multivariable Cox regression analysis and immune-related feature analysis. When the risk score model was applied in 22 breast cancer cohorts, the univariate Cox regression analysis demonstrated that the risk score model was significantly associated with overall survival in most of the breast cancer cohorts. Conclusion: Based on these results, we could conclude that the proposed risk score model may be a promising method, and may improve the treatment stratification of breast cancer patients in the future work.

A Predictive Risk Score for Cancer-Associated Thrombosis: Role of Screening In A Prospective Study

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3173-3173 ◽  
Author(s):  
Alok A. Khorana ◽  
Kimberly Herman ◽  
Deborah Rubens ◽  
Charles W. Francis
Keyword(s):  
High Risk ◽  
Cancer Patients ◽  
Risk Score ◽  
Prospective Cohort ◽  
Risk Model ◽  
Conflicts Of Interest ◽  
Clinical Risk Score ◽  
Clinical Risk ◽  
Predictive Risk

Abstract Abstract 3173 Background: We evaluated the utility of screening for VTE using a previously developed clinical risk score (Khorana et al, Blood 2008) in a prospective cohort of cancer patients initiating outpatient chemotherapy but not receiving thromboprophylaxis. Methods: Cancer patients initiating a new chemotherapy regimen and deemed high-risk based on a predictive risk model (score ≥3) were enrolled on an ongoing prospective cohort study with informed consent. Patients were evaluated with baseline and Q4 (± 1) week serial ultrasonography for upto 16 weeks; additionally, computed tomography scans for restaging were also evaluated for VTE. Results: Of 30 patients enrolled on study, 8 (27%) developed a VTE. This included 5 patients with DVT alone (17%), 1 patient with PE alone (3%) and 2 (7%) with both. Twenty-seven patients underwent a baseline ultrasound. Of these, 3 asymptomatic DVTs were identified (11%). Subsequent ultrasounds were performed in 18 patients at week 4 (0 DVT), 17 patients at week 8 (0 DVT) and 15 patients at week 12 (1 DVT, 7%). An additional two patients developed symptomatic DVT between weeks 1 and 4. Restaging CT scans identified an asymptomatic PE in 1 patient at week 6 and asymptomatic PE in 1 patient at week 9 with subsequent symptomatic DVT at week 10. Conclusions: In a prospective observational study, 27% of cancer outpatients deemed high-risk using a clinical risk score developed VTE, a rate much higher than observed even in hospitalized acutely ill patients. Thus, this study confirms the validity of a previously described risk score. The role of thromboprophylaxis in this population is currently being tested. The value of screening ultrasonography should be considered in high-risk patients based on this risk score. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Assessment of cardiotoxicity in breast cancer patients in the first cardio-oncology unit in Morocco: About 1092 cases

2021 ◽  
Vol 13 (1) ◽  
pp. 79
Author(s):  
R. Benmalek ◽  
I. Krikez ◽  
H. Bendahou ◽  
A. Maaroufi ◽  
A. Abouriche ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Breast Cancer Patients ◽  
Oncology Unit

scholarly journals Association between clinical risk factors and left ventricular function in patients with breast cancer following chemotherapy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Yamashita ◽  
H Tanaka ◽  
K Hatazawa ◽  
Y Tanaka ◽  
K Sumimoto ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Cancer Patients ◽  
Previous History ◽  
Left Ventricular ◽  
Clinical Risk Factors ◽  
Lv Function ◽  
Breast Cancer Patients ◽  
Clinical Risk ◽  
History Of

Abstract Background The sequential or concurrent use of two different types of agents such as anthracyclines and trastuzumab may increase myocardial injury and cancer therapeutics-related cardiac dysfunction (CTRCD), which is often the result of the combined detrimental effect of the two therapies for breast cancer patients. For risk stratification to detect the development of CTRCD, the current position paper from the European Society of Cardiology (ESC) lists several factors associated with risk of cardiotoxicity following treatment with chemotherapy. However, the association between clinical risk factors and left ventricular (LV) function in breast cancer patients is currently unclear. Purpose Our purpose was to investigate the impact of baseline risk factors on LV function in patients with preserved LV ejection fraction (LVEF) who have undergone anthracycline or trastuzumab chemotherapy for breast cancer. Methods We studied 86 breast cancer patients treated with anthracyclines, trastuzumab, or both. Mean age was 59±13 years and LVEF was 67±5%. In accordance with the current definition, CTRCD was defined as a decline in LVEF of &gt;10% to an absolute value of &lt;53% after chemotherapy. Based on the 2016 ESC position paper, clinical risk factors for CTRCD were defined as: (1) a cumulative total doxorubicin dose of ≥240 mg/m2, (2) age ≥65-year-old, (3) body mass index ≥30 kg/m2, (4) a previous history of radiation therapy to chest or mediastinum, (5) B-type natriuretic peptide ≥100pg/mL, (6) a previous history of cardiovascular disease, (7) atrial fibrillation, (8) hypertension, (9) diabetes mellitus, (10) current or ex-smoker. Results The relative decrease in LVEF after chemotherapy for patients with more than four risk factors was significantly greater than that for patients without (−9.3±10.8% vs. −2.2±10.2%; p=0.02). However, this finding did not apply to patients with more than one, two or three risk factors. Patients with more than four risk factors also tended to show a higher prevalence of CTRCD than those without (14.3% vs. 2.8%, p=0.12). Moreover, patients with more than four risk factors were more likely to have higher LV mass index (109.3±29.0 g/m2 vs. 83.2±21.0g /m2, p&lt;0.001), lower global longitudinal strain (18.4±2.8% vs. 20.0±2.6%, p=0.06) and higher E/e' (10.4 (8.9–13.0) vs. 9.0 (7.4–10.9), p=0.06) compared to those without. Conclusions Association between clinical risk factors and LV dysfunction following chemotherapy became stronger with an increase in the number of risk factors in breast cancer patients, and was especially strong for patients treated with chemotherapy who had more than four risk factors. Our findings can thus be expected to have clinical implications for better management of patients with breast cancer referred for chemotherapy. Funding Acknowledgement Type of funding source: None

Risk Score For Venous Thromboembolism (VTE) In Ambulatory Patients: Impact Of Cancer Type and Risk Score On VTE Incidence, Early Mortality and Progression-Free Survival

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 3597-3597
Author(s):  
Nicole M. Kuderer ◽  
Alok A. Khorana ◽  
Charles Francis ◽  
Eva Culakova ◽  
Gary H. Lyman
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Cancer Patients ◽  
Risk Score ◽  
Progression Free Survival ◽  
Early Mortality ◽  
Breast Cancer Patients ◽  
All Cause Mortality ◽  
Cancer Types ◽  
Risk Categories

Abstract Background While ambulatory patients receiving cancer chemotherapy are at increased risk for venous thromboembolism (VTE), current guidelines do not recommend routine thromboprophylaxis with a few notable exceptions (Lyman, Khorana et al, J Clin Oncol 2013). A previously validated VTE risk score for cancer outpatients stratifies patients into low (0), intermediate (1-2), or high (>=3) risk categories (Khorana, Kuderer et al, Blood 2008). Understanding cancer types at greatest risk for VTE as well as early mortality and progression based on the risk score provides key clinical understanding. Methods A prospective cohort study was conducted of consenting solid tumor and lymphoma patients initiating a new chemotherapy regimen at 115 randomly selected US oncology practices between 2002 – 2006 by the ANC Study Group. VTE incidence, progression-free survival (PFS), and all-cause mortality over the first 120 days (early mortality) of ambulatory chemotherapy were estimated based on the method of Kaplan and Meier. Results Among 4,458 patients initiating a new chemotherapy regimen, 93 (2.1%) developed a symptomatic VTE within 120 days of chemotherapy. The risk of VTE across cancer types increased from 0.6%, to 1.8% to 6.6% in low-, intermediate- and high-risk categories, respectively. The risk of VTE among low risk patients was 1% or less across all cancer types. However, the risk of VTE was highest among intermediate- and high-risk categories in patients with breast, colorectal, and lung cancer, reaching 16% for high risk breast cancer patients. Early all-cause mortality occurred in 136 patients (3.1%) and also increased with increasing risk score from 0.8% to 3.4% to 6.4% in low-, intermediate- and high-risk categories, respectively. The risk of early mortality was 2.1% or less in low risk patients across all cancer types. However, the risk of early mortality was highest among high-risk category patients, reaching 23% and 14% in colorectal cancer patients and pancreatic or gastric cancer patients, respectively. PFS decreased from 92% to 82% to 72% across the three risk categories, with lowest rates of PFS among colorectal (52%) and lung cancer (52%) patients. Conclusions VTE incidence and all-cause mortality increase and PFS correspondingly decreases with increasing VTE risk score across major solid tumors. Interestingly, while breast cancer is not considered a high risk tumor for VTE, breast cancer patients with a risk score of >=3 had the highest VTE incidence compared to other major solid tumor types. Among patients with a risk score of >=3, gastrointestinal cancer patients had the greatest risk of early mortality and correspondingly, the lowest PFS compared to other major solid tumors. These findings also suggest that both the mortality risk as well as the VTE risk are only partially influenced by tumor type. Funding: 1KM1-CA156687-01 (NK), ASCO Young Investigator Award (NK), NHLBI-1R01HL095109 (all), ANC Study Group (GL), and K23 CA120587 (AK). Disclosures: No relevant conflicts of interest to declare.

Sign in / Sign up

Export Citation Format

Share Document