A first approach to identifying cardiotoxic effects of breast cancer chemotherapeutic treatment in Kazakhstan

Zhenisgul Tlegenova 1, Saule Balmagambetova 2 * , Bekbolat Zholdin 1, Gulnara Kurmanalina 1, Iliada Talipova 1, Arip Koyshybaev 2, Ainel Urazova 2, Dinara Nurmanova 1, Olzhas Urazayev 2, Gulmira Sultanbekova 1, Kulparshan Kubenova 3, Mira Baspayeva 4
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1 Department of Internal Diseases-2, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
2 Department of Oncology, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
3 Clinical Lab, University's Medical Center, Aktobe, Kazakhstan
4 Chemotherapy Department, University`s Medical Center, Aktobe, Kazakhstan
* Corresponding Author
J CLIN MED KAZ, Volume 19, Issue 1, pp. 28-35. https://doi.org/10.23950/jcmk/11412
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ABSTRACT

As known, the clinical efficacy of chemotherapy is limited by the cardiotoxicity of drugs used.
The study aimed to clarify cardiotoxic complications of chemotherapy from the Aktobe Medical Center database for 2018-2019.       
Material and methods: We performed a register study on essential parameters of the oncological process, drugs used, duration of chemotherapy, types of complications, and outcomes, including survival.
Results: We found a total of 305 breast cancer cases. Chemotherapy was completed without complications in 65.9% of patients; treatment was interrupted due to complications - 10.5%; 6.2% of cardiovascular complications were identified. The two groups of patients, EchoCG + and EchoCG -, showed significant difference in the number of detected CV complications (p<.001) but no difference in the survival rate (p .814). The survival rate in patients with documented CV complications was 28.1 months vs. 34.3 months in the group without ones (p.005). The survival rate in those who completed the treatment without complications, was 34.9 months vs. 17.6 in individuals whose treatment was interrupted due to complications (p<.001). We performed a detailed review of four cases of cardiotoxicity with fatal outcomes.  
Conclusion: The analysis indicates the absence of a systematic approach to recording crucial information regarding cardiotoxicity. There is a lack of concordance in the actions of cardiologists and oncologists in the management of BC patients. The presence of lethal outcomes of chemotherapy with an established cause of cardiac death indicates the need to revise the cancer register management from the standpoint of cardio-oncology. In general, there is a need to develop local protocols for screening and monitoring patients undergoing cardiotoxic chemotherapy and radiation therapy.
 
Keywords: breast cancer, cancer register, chemotherapy, cardiovascular events, cardiotoxicity

CITATION

Tlegenova Z, Balmagambetova S, Zholdin B, Kurmanalina G, Talipova I, Koyshybaev A, et al. A first approach to identifying cardiotoxic effects of breast cancer chemotherapeutic treatment in Kazakhstan. J CLIN MED KAZ. 2022;19(1):28-35. https://doi.org/10.23950/jcmk/11412

REFERENCES

  • Bray F, Brewster DH, Gombe Mbalawa C, Kohler B, Pineros M, Steliarova-Foucher E, et al. Cancer incidence in five continents. J Cancer Clin. 2005; 55(2):74–108.
  • Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6):394-424. https://doi.org/10.3322/caac.21492
  • Ferlay J, Colombet M, Soerjomataram I, Parkin DM, Piñeros M, Znaor A, and Bray F. Cancer statistics for the year 2020: An overview. IntJCancer. 2021; https://doi.org/10.1002/ijc.33588
  • VoshchenkovaTA, ShanazarovNA, SeidalinNK, ErmakhanovaGA, BenberinVV, AkhetovAА, et al.Epidemiology Of Breast Cancer In Kazakhstan: Is It Possible To Change Global Trends? Res J Pharm Biol Chem Sci. 2019; 10(1):2129-2135.
  • Shuykova KV, EmelinaEL, Gendlin GE, Storojakov GL. Izmeneniya funkziilevogo zheludochka serdza u bol’nych s limfomami na fone vvedeniya antraziklinovych antibiotikov (Change of the left ventricle functioning in lymphoma treated with anthracycline antibiotics) [in Russian]. RKZh [Russ J Cardiol]. 2016; 1: 41-46. https://doi.org/10.15829/1560-4071-2016-1-41-46
  • Zamorano JL, Lancellotti P, Rodriques MD, Aboyans V, Asteggiano R, GalderisiM, et al. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guldelines: The Task Force for cancer treatment and cardiovascular toxicity of the European Society of Cardioloqy (ESC). Eur Heart J. 2016; 37(36):2768-2801. https://doi.org/10.1093/eurheartj/ehw211
  • McGoman JV, Chung R, Maulik A, Piotrowska I, Walker JM, Yellon DM. Anthracycline Chemotherapy and Cardiotoxicity. Cardiovasc Drugs Ther. 2017; 31(1):63-75. https://doi.org/10.1007/s10557-016-6711-0
  • Gernaat SAM, Ho PJ, Rijnberg N, Emaus MJ, Baak LM, Hartman M, et al. Risk of death from cardiovascular disease following breast cancer: a systematic review. Breast Cancer Res Treat. 2017; 164(3): 537-555. https://doi.org/10.1007/s10549-017-4282-9
  • Gendlin GE, Emelina EI, Nikitin IG, Vasyuk YA. Sovremennyy vzglyad na kardiotoksichnost' khimioterapii onkologicheskikh zabolevaniy, vklyuchayushchey antratsiklinovye antibiotiki [Modern view on cardiotoxicity of chemotherapeutics in oncology including anthracyclines]. RKZh [Russ J Cardiol]. 2017; 3(143):145-154. https://doi.org/10.15829/1560-4071-2017-3-145-154
  • Hamo CE, Bloom MW, Cardinale D, Ky B, Nohria A, et al. Cancer Therapy-Related Cardiac Dysfunction and Heart Failure: Part 2: Prevention, Treatment, Guidelines, and Future Directions. Circ Heart Fail. 2016; 9(2):e002843. https://doi.org/10.1161/CIRCHEARTFAILURE.115.002843
  • Lenihan DJ, Oliva S, Chow EJ, Cardinale D. Cardiac toxicity in cancer survivors. Cancer. 2013; 119(11):2131-42. https://doi.org/10.1002/cncr.28061
  • Bowles EJ, Wellman R, Feigelson HS, Onitilo AA, Freedman AN, Delate T, et al. Pharmacovigilance Study Team. Risk of heart failure in breast cancer patients after anthracycline and trastuzumab treatment: a retrospective cohort study. J Natl Cancer Inst. 2012; 104(17):1293-1305. https://doi.org/10.1093/jnci/djs317
  • Patnaik JL, Byers T, Di Guiseppi C, Dabelea D, Denberg TD. Cardiovascular disease competes with breast cancer as the leading cause of death for older females diagnosed with breast cancer: a retrospective cohort study. Breast Cancer Res. 2011; 13(3):R64. https://doi.org/10.1186/bcr2901
  • O'Brien PJ. Cardiac troponin is the most effective translational safety biomarker for myocardial injury in cardiotoxicity. Toxicology. 2008; 245(3):206-218. https://doi.org/10.1016/j.tox.2007.12.006
  • Slamon D, Eiermann W, Robert N, Pienkowski T, Martin M, Press M, et al. Breast Cancer International Research Group. Adjuvant trastuzumab in HER2-positive breast cancer. N Engl J Med. 2011; 365(14):1273-83. https://doi.org/10.1056/NEJMoa0910383
  • Altena R, Perik PJ, van Veldhuisen DJ, de Vries EG, Gietema JA. Cardiovascular toxicity caused by cancer treatment: strategies for early detection. Lancet Oncol. 2009; 10:391–399. https://doi.org/10.1016/S1470-2045(09)70042-7
  • Thomas SA. Chemotherapy Agents That Cause Cardiotoxicity.US Pharm. 2017; 42(9):HS24-HS33.
  • Ben Kridis W, Sghaier S, Charfeddine S, Toumi N, Daoud J, Kammoun S, et al. Prospective Study About Trastuzumab-induced Cardiotoxicity in HER2-positive Breast Cancer. Am J Clin Oncol. 2020; 43(7):510-516. https://doi.org/10.1097/COC.0000000000000699
  • Arrigo M., Jessup M., Mullens W. et al. Acute heart failure. Nat Rev Dis Primers. 2020; 6(16). https://doi.org/10.1038/s41572-020-0151-7
  • Alkofide H, Alnaim L, Alorf N, Alessa W, Bawazeer G. Cardiotoxicity and Cardiac Monitoring Among Anthracycline-Treated Cancer Patients: A Retrospective Cohort Study. Cancer Manag Res. 2021; 13:5149-5159. https://doi.org/10.2147/CMAR.S313874
  • Cardinale D, Ciceri F, Latini R, Franzosi MG, Sandri MT, Civelli M, et al; ICOS-ONE Study Investigators. Anthracycline-induced cardiotoxicity: A multicenter randomised trial comparing two strategies for guiding prevention with enalapril: The International CardioOncology Society-one trial. Eur J Cancer. 2018; 94:126-137. https://doi.org/10.1016/j.ejca.2018.02.005
  • Zardavas D, Suter TM, Van Veldhuisen DJ, Steinseifer J, Noe J, et al. Role of Troponins I and T and N-Terminal Prohormone of Brain Natriuretic Peptide in Monitoring Cardiac Safety of Patients With Early-Stage Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer Receiving Trastuzumab: A Herceptin Adjuvant Study Cardiac Marker Substudy. J Clin Oncol. 2017; 10:35(8):878-884. https://doi.org/10.1200/JCO.2015.65.7916
  • Pai VB, Nahata MC. Cardiotoxicity of chemotherapeutic agents: incidence, treatment and prevention. Drug Saf. 2000; 22(4):263-302. https://doi.org/10.2165/00002018-200022040-00002
  • Armenian SH, Lacchetti C, Barac A, Carver J,Constine LS, Denduluri N, et al. Prevention and Monitoring ofCardiac Dysfunction in Survivors of Adult Cancers: American Society of Clinical Oncology ClinicalPractice Guideline. J Clin Oncol. 2017; 35(8):893-911. https://doi.org/10.1200/JCO.2016.70.5400
  • Thavendiranathan P, Poulin F, Lim KD, Plana JC, WooA, Marwick TH. Use of myocardial strain imaging by echocardiography for the early detection of cardiotoxicity in patients during and after cancer chemotherapy: a systematic review. J AmColl Cardiol. 2014; 63(25 Pt A):2751-2768. https://doi.org/10.1016/j.jacc.2014.01.073
  • Semeraro GC, Lamantia G, Cipolla CM, Cardinale D. How to identify anthracycline‑inducedcardiotoxicity early and reduce its clinicalimpact in everyday practice. Kardiologia Polska. 2021; 79(2). https://doi.org/10.33963/KP.15782
  • Curigliano G, Cardinale D, Dent S, Criscitiello C, Aseyev O, Lenihan D, Cipolla CM. Cardiotoxicity of anticancer treatments: Epidemiology, detection, and management. CA Cancer J Clin. 2016; 66(4):309-325. https://doi.org/10.3322/caac.21341
  • Guglin M, Krischer J, Tamura R, Fink A, Bello-Matricaria L, et al.Randomized Trial of Lisinopril Versus Carvedilol to Prevent Trastuzumab Cardiotoxicity in Patients WithBreast Cancer. J Am Coll Cardiol. 2019; 73(22):2859-2868. https://doi.org/10.1016/j.jacc.2019.03.495