CardiomyopathyEarly Detection and Prediction of Cardiotoxicity in Chemotherapy-Treated Patients
Section snippets
Methods
Patients >18 years of age diagnosed with HER-2-overexpressing breast cancer and either scheduled to receive treatment including anthracyclines and trastuzumab or scheduled to receive trastuzumab after previous anthracycline treatment were eligible. Patients with LVEFs <50% were excluded.
Patients were enrolled at 4 institutions. All patients signed informed consent forms, which were approved by the institutional review board of the participating institutions.
Patients were studied before
Results
Forty-five eligible consecutive women were prospectively enrolled in the study. One woman withdrew from the study and 1 was withdrawn because of negative HER-2 status on a second analysis. Therefore, a total of 43 women participated in the study. Ten women received anthracyclines before entering the study. The median delay time between the anthracycline treatment and the initial study time point was 3.5 months (range 2 to 144). There was no difference in the baseline or changes in the clinical
Discussion
In the present study, we report that in patients treated with a combination of anthracyclines and trastuzumab, an early decrease in myocardial strain or elevation in plasma troponin as detected with a high-sensitivity assay predicts the later occurrence of cardiotoxicity. Subsequent cardiotoxicity is not clearly predicted by early changes in the LVEF or NT-proBNP level.
Patients enrolled in our study experienced decreases in the LVEF of similar magnitude as those reported previously in patients
Acknowledgment
We would like to thank Laurie Farrell, RN, from the Cardiology Division for her help in the blood sampling and processing; Alisha Polewarczyk from the Gillette Center for Breast Cancer of Massachusetts General Hospital for her contribution in recruiting patients; Stephanie Fuoco, RN, from the Sir Mortimer B. Davis-Jewish General Hospital and McGill University and Jose Banchs, MD, Liza Sanchez, BS, and Mona Massey, RN, from the M.D. Anderson Cancer Center for coordinating patient enrollment; and
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Dr. Scherrer-Crosbie was supported by an investigator-initiated grant from the Susan G. Komen for the Cure Foundation, Dallas, Texas, a Claflin Distinguished Scholar Award, and a Clinical Innovation Award, Boston, Massachusetts. Dr. Ky was supported by the Kynett Focus Junior Faculty Investigator Award, Philadelphia, Pennsylvania.
Dr. Januzzi has received grant support from Roche Diagnostics GmbH, Mannheim, Germany, Siemens Medical Systems, Erlangen, Germany, and Critical Diagnostics, San Diego, California. Dr. Plana is on the speaker's bureau of GE Healthcare, Milwaukee, Wisconsin.