Key result
A cumulative anthracycline dose of ≥ 350 mg/m2 significantly increased the risk of sub-clinical cardiotoxicity, indicated by elevated cardiac troponin I, in breast cancer patients (OR 7.28).
Why the study?
Prevalence data regarding anthracycline-induced cardiotoxicity in Sri Lanka were lacking, despite the known risk of cumulative dose-dependent cardiotoxicity.
Does anthracycline chemotherapy induce sub-clinical cardiotoxicity detectable by ECG and biomarkers in breast cancer patients?
Cross-Sectional (n=196)
No
Does anthracycline chemotherapy induce sub-clinical cardiotoxicity detectable by ECG and biomarkers in breast cancer patients?
Anthracycline chemotherapy in breast cancer patients induces significant sub-clinical cardiotoxic changes detectable by ECG and biomarkers at 6 months, particularly at cumulative doses >350 mg/m2.
Answers are grounded in this paper and cite their sources.
Should not yet change anthracycline dosing; hypothesis-generating for troponin monitoring in breast cancer.
Background The clinical application of anthracycline chemotherapy is hindered due to the cumulative dose-dependent cardiotoxicity followed by the oxidative stress initiated during the mechanism of action of anthracyclines. Due to a lack of prevalence data regarding anthracycline-induced cardiotoxicity in Sri Lanka, this study was conducted to determine the prevalence of cardiotoxicity among breast cancer patients in Southern Sri Lanka in terms of electrocardiographic and cardiac biomarker investigations. Methods A cross-sectional study with longitudinal follow-up was conducted among 196 cancer patients at the Teaching Hospital, Karapitiya, Sri Lanka to determine the incidence of acute and early-onset chronic cardiotoxicity. Data on electrocardiography and cardiac biomarkers were collected from each patient, one day before anthracycline (doxorubicin and epirubicin) chemotherapy, one day after the first dose, one day and six months after the last dose of anthracycline chemotherapy. Results Prevalence of sub-clinical anthracycline-induced cardiotoxicity six months after the completion of anthracycline chemotherapy was significantly higher ( p < 0.05) and there were strong, significant ( p < 0.05) associations among echocardiography, electrocardiography measurements and cardiac biomarkers including troponin I and N-terminal pro-brain natriuretic peptides. The cumulative anthracycline dose, > 350 mg/m 2 was the most significant risk factor associated with the sub-clinical cardiotoxicity in breast cancer patients under study. Conclusion Since these results confirmed the unavoidable cardiotoxic changes following anthracycline chemotherapy, it is recommended to carry out long-term follow-ups in all patients who were treated with anthracycline therapy to increase their quality of life as cancer survivors.
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Sandamali et al. (2023) conducted a cross-sectional in Breast cancer (n=196). Cumulative anthracycline dose ≥ 350 mg/m2 vs. Cumulative anthracycline dose < 350 mg/m2 was evaluated on Elevated cardiac troponin I (≥ 0.04 ng/mL) at six months post-chemotherapy (OR 7.28, 95% CI 3.81-13.84, p=0.001). A cumulative anthracycline dose of ≥ 350 mg/m2 significantly increased the risk of sub-clinical cardiotoxicity, indicated by elevated cardiac troponin I, in breast cancer patients (OR 7.28).
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