Key result
Anthracycline-based therapies in breast cancer patients led to a ≥15% reduction in global longitudinal strain in 61.6% of patients, with the worst impairment seen with FEC plus taxanes.
Why the study?
It was unclear whether different adjuvant drugs impact cardiac function differently and whether their cardiotoxicity exhibits a regional pattern in breast cancer patients treated with anthracycline-based therapies.
Do different anthracycline-based adjuvant therapies impact cardiac function and regional myocardial damage differently in breast cancer patients?
Cohort (n=146)
Yes
Do different anthracycline-based adjuvant therapies impact cardiac function and regional myocardial damage differently in breast cancer patients?
Global longitudinal strain detects early regional myocardial damage in breast cancer patients receiving anthracyclines, with more pronounced impairment in those receiving fluorouracil, epirubicin, cyclophosphamide, and taxanes, especially when combined with trastuzumab.
May warrant regimen-specific monitoring in anthracycline-treated BC patients; hypothesis-generating for regional patterns pending confirmation.
AIMS: In breast cancer (BC) patients treated with anthracyclines-based therapies, we aim at assessing whether adjuvant drugs impact cardiac function differently and whether their cardiotoxicity has a regional pattern. METHODS AND RESULTS: In a multicentre study, 146 BC patients (56 ± 11 years) were prospectively enrolled and divided into three groups according to the received treatments: AC/EC-Group (doxorubicin or epirubicin + cyclophosphamide), AC/EC/Tax-Group (AC/EC + taxanes), FEC/Tax-Group (fluorouracil + EC + taxanes). Fifty-six patients of the total cohort also received trastuzumab. Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) were calculated before starting chemotherapy (T0), at 3 months (T3), at 6 (T6), and 12 months (T12). A ≥10% drop of EF, while remaining within the normal range, was reached at T6 in 25.3% of patients from the whole cohort with an early decrease only in FEC/Tax-Group (P = 0.04). A ≥15% GLS reduction was observed in many more (61.6%) patients. GLS decreased early both in the whole population (P < 0.001) and in the subgroups. The FEC-Tax Group showed the worst GLS at T6. Trastuzumab further worsened GLS at T12 (P = 0.031). A significant reduction of GLS was observed in all LV segments and was more relevant in the anterior septum and apex. CONCLUSIONS: The decrease of GLS is more precocious and pronounced in BC patients who received FEC + taxanes. Cardiac function further worsens after 6 months of adjuvant trastuzumab. All LV segments are damaged, with the anterior septum and the apex showing the greatest impairments.
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Zito et al. (2020) conducted a cohort in Breast cancer (n=146). Anthracyclines-based therapies vs. Different anthracycline regimens was evaluated on ≥10% drop of LVEF and ≥15% reduction in global longitudinal strain (GLS). Anthracycline-based therapies in breast cancer patients led to a ≥15% reduction in global longitudinal strain in 61.6% of patients, with the worst impairment seen with FEC plus taxanes.
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