Markers Identified for Cardiotoxicity Due to Chemotherapy for Breast Cancer

The following article features coverage from the 2017 San Antonio Breast Cancer Symposium (SABCS) in San Antonio, Texas. Click here to read more of Oncology Nurse Advisor‘s conference coverage.

Early cardiotoxicity may be detectable by utilizing echocardiography and serum markers in patients with breast cancer who received chemotherapy, according to study results to be presented at the 2017 San Antonio Breast Cancer Symposium.

Although cardiotoxicity is a known adverse event among patients treated with chemotherapy, there is a need to explore the rate at which it occurs. The purpose of this study was to identify early markers for cardiotoxicity.

For the prospective study, researchers identified 97 patients with breast cancer who were treated with chemotherapy, and analyzed various biomarkers (eg, natriuretic peptide, ultra-sensitive T troponin), echocardiography parameters (left ventricular ejection fraction [LVEF] and global longitudinal strain [GLS]), and electrocardiograms. Researchers defined cardiotoxicity as a greater than 10% reduction in LVEF among asymptomatic patients with LVEF less than 55%, and a greater than 5% reduction in LVEF among symptomatic patients with LVEF less than 55%. 

Biomarker analysis was performed with each cycle of chemotherapy, and cardiology assessments were completed at baseline prior to chemotherapy initiation, 3 months afterwards, and then every 6 months for 5 years. All patients had LVEF within the normal range at baseline.

The median follow-up for the cohort was 26.5 months. Approximately 10% and 2% of asymptomatic and symptomatic patients, respectively, experienced cardiotoxicity; 5 patients were treated with heart failure therapies including ACE inhibitors and beta blockers, of which 2 patients recovered basal LVEF levels, 2 maintained LVEF dysfunction, and 1 died. Of all study patients, 83.3% reported cardiotoxicity during the first year of follow-up.

The authors also noted that a subset of patients who did not meet the study definitions of cardiotoxicity still experienced a reduction in LVEF, but also tended to recover without treatment.

A positive association was observed in a model that evaluated the association of miRNA 21-5p, miRNA-133b, miRNA 210-3p, miRNA 423-5p, and miRNA-663b with decreased LVEF.

The authors of the study concluded that assessing cardiotoxicity via echocardiography and serum markers allows “an opportunity to start heart failure therapy on time with the aim of improving the control and evolution of [heart failure].”

Reference

Salvador-Coloma C, Hernándiz A, Tejedor S, et al. Early detection of chemotherapy-induced cardiotoxicity in breast cancer patients. Poster presentation at: 2017 San Antonio Breast Cancer Symposium; December 5-9, 2017; San Antonio, TX.