Stratifying breast cancer patients by baseline risk of cardiotoxic complications linked to chemotherapy
Zhenisgul Tlegenova 1,
Saule Balmagambetova 2 * ,
Bekbolat Zholdin 1,
Gulnara Kurmanalina 1,
Iliada Talipova 1,
Arip Koyshybaev 2,
Dinara Nurmanova 1,
Gulmira Sultanbekova 1,
Mira Baspayeva 3,
Saule Madinova 3,
Kulparshan Kubenova 4,
Ainel Urazova 2 More Detail
1 Department of Internal Diseases-2, West Kazakhstan Marat Ospanov State Medical University, Aktobe, Kazakhstan
2 Department of Oncology, West Kazakhstan Marat Ospanov State Medical University, Aktobe, Kazakhstan
3 Chemotherapy Division, University`s Medical Center, Aktobe, Kazakhstan
4 Clinical Lab, University's Medical Center, Aktobe, Kazakhstan
* Corresponding Author
J CLIN MED KAZ, Volume 20, Issue 3, pp. 75-81.
https://doi.org/10.23950/jcmk/13325
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ABSTRACT
A majority of modern antitumor pharmaceuticals are accompanied by cardiotoxicity. The study aims to present practical approaches to stratifying the baseline risk of antitumor therapies' cardiotoxicity in patients newly diagnosed with breast cancer started on anthracyclines and/or trastuzumab.
Material and methods: Stratifying the risks of antitumor therapy was carried out according to the European Society of Cardiology recommendations. A therapist examined all patients for existing cardiovascular diseases and risk factors detection. The blood levels of glucose, cholesterol, creatinine, cardiac troponin I, and brain natriuretic peptide were determined. Electrocardiography and echocardiography with an assessment of the myocardium global longitudinal strain were performed.
Results: In total, 128 breast cancer patients with a mean age of 54.3±11.0 years were included in the study. Of them, 84.4% had tumor stages I and II, and 21.1% were HER2-positive. Chronic heart failure and ischemic heart disease were detected in 2.3%. Among the risk factors, the most common were arterial hypertension (51.6%), obesity (29.7%), age 65-70 years (18%), significant smoking history (15.6%), and diabetes mellitus (11.7%). Elevated cardiac troponin I and brain natriuretic peptide baseline levels were present in 5.5% and 7.0% of patients, respectively. To a high-risk group for cardiotoxic complications, 7.8% were allocated, 35.7% were assigned to the moderate-risk group, and 54.7% had low risk. High/very high and moderate-risk patients (43.5%) were referred to a cardiologist. Cardioprotective treatment was started immediately in high/very high-risk patients.
Conclusion: All revealed differences between the cardiovascular risk groups were related to age, cardiovascular system condition, and the severity of comorbid pathologies. The baseline stratification of patients into risk groups is a crucial step in preventing the cardiotoxicity of anticancer therapy. Comprehensive assessing the patient's condition before and during chemotherapy allows for avoiding the development of fatal cardiovascular complications in at-risk patients.
CITATION
Tlegenova Z, Balmagambetova S, Zholdin B, Kurmanalina G, Talipova I, Koyshybaev A, et al. Stratifying breast cancer patients by baseline risk of cardiotoxic complications linked to chemotherapy. J CLIN MED KAZ. 2023;20(3):75-81.
https://doi.org/10.23950/jcmk/13325
REFERENCES
- Miller KD, Nogueira L, Devasia T, Mariotto AB, Yabroff KR, Jemal A, et al. Cancer treatment and survivorship statistics, 2022. CA Cancer J Clin. 2022; 72(5):409-36. https://doi.org/10.3322/caac.21731
- López-Sendón J, Álvarez-Ortega C, Zamora Auñon P, Buño Soto A, Lyon AR, Farmakis D, et al. Classification, prevalence, and outcomes of anticancer therapy-induced cardiotoxicity: the CARDIOTOX registry. Eur Heart J. 2020; 41(18):1720-29. https://doi.org/10.1093/eurheartj/ehaa006
- McGowan 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
- Chasouraki A, Kourek C, Sianis A, Loritis K, Kostakou P, Tsougos E, et al. Practical Approaches to Build and Sustain a Cardio-Oncology Clinic. J Cardiovasc Dev Dis. 2022; 9(5):158. https://doi.org/10.3390/jcdd9050158
- Cardinale D, Ciceri F, Latini R, Franzosi MG, Sandri MT, Civelli M, et al. 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; 94:126-37. https://doi.org/10.1016/j.ejca.2018.02.005
- Christidi E, Brunham LR. Regulated cell death pathways in doxorubicin-induced cardiotoxicity. Cell Death Dis. 2021; 12(4):339. https://doi.org/10.1038/s41419-021-03614-x
- Briasoulis A, Chasouraki A, Sianis A, Panagiotou N, Kourek C, Ntalianis A, Paraskevaidis I. Cardiotoxicity of Non-Anthracycline Cancer Chemotherapy Agents. J Cardiovasc Dev Dis. 2022; 9(3):66. https://doi.org/10.3390/jcdd9030066
- Ben Kridis W, Sghaier S, Charfeddine S, Toumi N, Daoud J, Kammoun S, Khanfir A. A 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
- Ganesh S, Zhong P, Zhou X. Cardiotoxicity induced by immune checkpoint inhibitor: The complete insight into mechanisms, monitoring, diagnosis, and treatment. Front Cardiovasc Med. 2022; 9:997660. https://doi.org/10.3389/fcvm.2022.997660
- Groarke JD, Nguyen PL, Nohria A, Ferrari R, Cheng S, Moslehi J. Cardiovascular complications of radiation therapy for thoracic malignancies: the role for non-invasive imaging for detection of cardiovascular disease. Eur Heart J. 2014; 35(10):612-23. https://doi.org/10.1093/eurheartj/eht114
- Ades F, Zardavas D, Pinto AC, Criscitiello C, Aftimos P, de Azambuja E. Cardiotoxicity of systemic agents used in breast cancer. Breast. 2014; 23(4):317-28. https://doi.org/10.1016/j.breast.2014.04.002
- Zamorano JL, Lancellotti P, Rodriguez Muñoz D, Aboyans V, Asteggiano R, Galderisi M, et al. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: The Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC). Eur J Heart Fail. 2017; 19(1):9-42. https://doi.org/10.1002/ejhf.654
- Tlegenova Zh, Zholdin BK, Gendlin GE, Balmagambetova SK, Kurmanalina GL, Talipova I. Prognosticheskiy potentcial troponina v diagnostike kardiotoksichnosti pri himioterapii antraciklinami i monoklonalnymi antitelami u bolnyh rakom molochnoi zhelezy [in Russian]. (The Troponin prognostic capability in diagnosing cardiotoxicity during chemotherapy with anthracyclines and monoclonal antibodies in breast cancer patients). Nauka i Zdravookhranenie [Science & Healthcare]. 2021; 23(5):132-48. https://doi.org/10.34689/SH.2021.23.5.016
- Lancellotti P, Suter TM, López-Fernández T, Galderisi M, Lyon AR, van der Meer P, et al. Cardio-Oncology Services: rationale, organization, and implementation: A report from the ESC Cardio-Oncology council. Eur Heart J. 2019; 40(22):1756–63. https://doi.org/10.1093/eurheartj/ehy453
- Balmagambetova S, Tlegenova Z, Zholdin B, Kurmanalina G, Talipova I, Koyshybaev A, et al. Early Diagnosis of Chemotherapy-Linked Cardiotoxicity in Breast Cancer Patients Using Conventional Biomarker Panel: A Prospective Study Protocol. Diagnostics. 2022; 12:2714. https://doi.org/10.3390/diagnostics12112714
- Pudil R, Mueller C, Čelutkienė J, Henriksen PA, Lenihan D, Dent S, et al. Role of serum biomarkers in cancer patients receiving cardiotoxic cancer therapies: a position statement from the Cardio-Oncology Study Group of the Heart Failure Association and the Cardio-Oncology Council of the European Society of Cardiology. Eur J Heart Fail. 2020; 22(11):1966-83. https://doi.org/10.1002/ejhf.2017
- Lyon AR, Dent S, Stanway S, Earl H, Brezden-Masley C, Cohen-Solal A, et al. Baseline cardiovascular risk assessment in cancer patients scheduled to receive cardiotoxic cancer therapies: a position statement and new risk assessment tools from the Cardio-Oncology Study Group of the Heart Failure Association of the European Society of Cardiology in collaboration with the International Cardio-Oncology Society. Eur J Heart Fail. 2020; 22(11):1945-60. https://doi.org/10.1002/ejhf.1920
- Unguryanu TN, Grjibovski AM. Analysis Of Three Independent Groups Using Non-Parametric Kruskal-Wallis Test In Stata Software. Ekologiya cheloveka (Human Ecology) 2014; 21(6): 55-8. https://doi.org/10.17816/humeco17232
- Chan Y, Walmsley RP. Learning and understanding the Kruskal-Wallis one-way analysis-of-variance-by-ranks test for differences among three or more independent groups. Phys Ther. 1997; 77(12): 1755-62. https://doi.org/10.1093/ptj/77.12.1755
- Vasyuk Yu, Gendlin G, Emelina E, Shupenina E, Ballyuzek M, Barinova I, Vitsenya M, et al. Сonsensus statement of Russian experts on the prevention, diagnosis and treatment of cardiotoxicity of anticancer therapy [in Russian]. Russian Journal of Cardiology. 2021; 26(9):4703. https://doi.org/10.15829/1560-4071-2021-4703
- Larsen CM, Mulvagh SL. Cardio-oncology: what you need to know now for clinical practice and echocardiography. Echo Res Pract. 2017; 4(1):R33-R41. https://doi.org/10.1530/ERP-17-0013
- Smiseth OA, Torp H, Opdahl A, Haugaa KH, Urheim S. Myocardial strain imaging: how useful is it in clinical decision making? Eur Heart J. 2016; 37(15):1196-207. https://doi.org/10.1093/eurheartj/ehv529
- Lyon AR, López-Fernández T, Couch LS, Asteggiano R, Aznar MC, Bergler-Klein J, et al. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J Cardiovasc Imaging. 2022; 23(10):e333-e465. https://doi.org/10.1093/ehjci/jeac106
- Plana JC, Galderisi M, Barac A, Ewer MS, Ky B, Scherrer-Crosbie M, et al. Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2014; 15(10):1063-93. https://doi.org/10.1093/ehjci/jeu192
- Čelutkienė J, Pudil R, López-Fernández T, Grapsa J, Nihoyannopoulos P, Bergler-Klein J, et al. Role of cardiovascular imaging in cancer patients receiving cardiotoxic therapies: a position statement on behalf of the Heart Failure Association (HFA), the European Association of Cardiovascular Imaging (EACVI) and the Cardio-Oncology Council of the European Society of Cardiology (ESC). Eur J Heart Fail. 2020;22(9):1504-24. https://doi.org/10.1002/ejhf.1957
- Cardinale D, Colombo A, Bacchiani G, Tedeschi I, Meroni CA, Veglia F, et al. Early detection of anthracycline cardiotoxicity and improvement with heart failure therapy. Circulation. 2015; 131(22):1981-8. https://doi.org/10.1161/CIRCULATIONAHA.114.013777
- de Baat EC, Mulder RL, Armenian S, Feijen EA, Grotenhuis H, Hudson MM, Mavinkurve-Groothuis AM, et al. Dexrazoxane for preventing or reducing cardiotoxicity in adults and children with cancer receiving anthracyclines. Cochrane Database Syst Rev. 2022; 9(9):CD014638. https://doi.org/10.1002/14651858.CD014638.pub2
- Lewinter C, Nielsen TH, Edfords LR, Linde C, Bland JM, LeWinter M, et al. Systematic review and meta-analysis of beta-blockers and renin-angiotensin system inhibitors for preventing left ventricular dysfunction due to anthracyclines or trastuzumab in patients with breast cancer. Eur Heart J. 2021: ehab843. https://doi.org/10.1093/eurheartj/ehab843
- van Dalen EC, van der Pal HJ, Kremer LC. Different dosage schedules for reducing cardiotoxicity in people with cancer receiving anthracycline chemotherapy. Cochrane Database Syst Rev. 2016; 3(3):CD005008. https://doi.org/10.1002/14651858.CD005008.pub4
- Rafiyath SM, Rasul M, Lee B, Wei G, Lamba G, Liu D. Comparison of safety and toxicity of liposomal doxorubicin vs. conventional anthracyclines: a meta-analysis. Exp Hematol Oncol. 2012;1(1):10. https://doi.org/10.1186/2162-3619-1-10
- Curigliano C, Lenihan D, Fradley M, Ganatra S, Barac A, Blaes A, et al. Management of cardiac disease in cancer patients throughout oncological treatment: ESMO consensus recommendations. Ann Oncol. 2020; 31:171–90. https://doi.org/10.1016/j.annonc.2019.10.023
- Shakir DK, Rasul KI. Chemotherapy induced cardiomyopathy: pathogenesis, monitoring and management. J Clin Med Res. 2009; 1(1):8-12. https://doi.org/10.4021/jocmr2009.02.1225