Journal of Cardio-Thoracic Medicine

Journal of Cardio-Thoracic Medicine

Echocardiographic Assessment of Ventricular Cardiomyopathy in Patients with Breast Cancer under Trastuzumab Chemotherapy

Document Type : Original Article

Authors
Nakisa Khansari 1
Paria Shahbazi 1
Shahram Homayounfar 1
Mohammad Abbasi 2
Abbas Moradi 3
Parinaz Sedighi 4, 5
1 Department of Cardiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
2 Department of Internal Medicine, School of Medicine, Shahid Beheshti Medical Educational Center, Hamadan University of Medical Sciences, Hamadan, Iran
3 Department of Community Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
4 Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
5 Universal Scientific Education and Research Network (USERN), Tehran, Iran
10.22038/jctm.2024.79819.1458
Abstract
Introduction: Breast cancer is the most common cancer and the leading cause of cancer-related death among women worldwide. Breast cancer treatment has been improved by the development of targeted chemotherapies such as antibodies against HER2 receptors and now Trastuzumab is the standard treatment for HER2 positive breast cancer. Cardiotoxicity is the most prominent adverse effect of Trastuzumab that restricts the usage of this drug. This study is designed to assess cardiomyopathy in patients with breast cancer under Trastuzumab chemotherapy with special respect to both right and left ventricles.
Materials and Methods: A total number of 38 cases were evaluated. Echocardiography was done at the baseline and three to six months after the initiation of Trastuzumab chemotherapy.
Results: According to the second echocardiography 24 cases (63.8%) developed cardiotoxicity based on decrease in ejection fraction or decrease in the absolute value of the left and/or right ventricular Global Longitudinal Strain (LV and/or RV GLS). There was a significant difference between the mean values of echocardiographic indices including RVSm, RV Tei-index, LV Tei-index, RV GLS, LV GLS, LVEF, MAPSE, and TAPSE before and after chemotherapy (the p-value for comparison of MAPSE was 0.006, and the p-value for comparison of other parameters was <0.001). There was no significant difference in terms of cardiotoxicity between the group that received radiotherapy in addition to chemotherapy and the group that did not receive radiotherapy.
Conclusion: In conclusion, the best way to minimize Trastuzumab-induced cardiotoxicity is intensive follow-up by echocardiography to detect cardiac impairments in the early stages. Also, the study demonstrated the uniqueness of longitudinal strain especially LV-GLS for early detection of cardiotoxicity.
Keywords
Cardiomyopathies
Cardiotoxicity
Breast neoplasms
Trastuzumab
Echocardiography
  1. Noone AM, Cronin KA, Altekruse SF, Howlader N, Lewis DR, Petkov VI, et al. Cancer Incidence and Survival Trends by Subtype Using Data from the Surveillance Epidemiology and End Results Program, 1992-2013. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2017;26(4):632-41.
  2. Calleja A, Poulin F, Khorolsky C, Shariat M, Bedard PL, Amir E, et al. Right Ventricular Dysfunction in Patients Experiencing Cardiotoxicity during Breast Cancer Therapy. Journal of Oncology. 2015;2015:609194.
  3. Cortazar P, Zhang L, Untch M, Mehta K, Costantino JP, Wolmark N, et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. The Lancet. 2014;384(9938):164-72.
  4. Sikov WM. Neoadjuvant therapy for patients with HER2-positive breast cancer. In: Post TW, editor. UpToDate. Waltham, MA.: UpToDate; 2022.
  5. Schott AF. Systemic treatment for HER2-positive metastatic breast cancer. In: Post TW, editor. UpToDate. Waltham, MA.: UpToDate; 2022.
  6. Kreutzfeldt J, Rozeboom B, Dey N, De P. The trastuzumab era: current and upcoming targeted HER2+ breast cancer therapies. Am J Cancer Res. 2020;10(4):1045-67.
  7. Mazzotta M, Krasniqi E, Barchiesi G, Pizzuti L, Tomao F, Barba M, et al. Long-Term Safety and Real-World Effectiveness of Trastuzumab in Breast Cancer. Journal of Clinical Medicine. 2019;8(2).
  8. Yousif NG, Al-amran FG. Novel Toll-like receptor-4 deficiency attenuates trastuzumab (Herceptin) induced cardiac injury in mice. BMC Cardiovascular Disorders. 2011;11(1):62.
  9. Mohan N, Jiang J, Dokmanovic M, Wu WJ. Trastuzumab-mediated cardiotoxicity: current understanding, challenges, and frontiers. Antibody Therapeutics. 2018;1(1):13-7.
  10. ElZarrad MK, Mukhopadhyay P, Mohan N, Hao E, Dokmanovic M, Hirsch DS, et al. Trastuzumab alters the expression of genes essential for cardiac function and induces ultrastructural changes of cardiomyocytes in mice. PLoS One. 2013;8(11):e79543-e.
  11. Blanter JB, Frishman WH. The Preventive Role of Angiotensin Converting Enzyme Inhibitors/Angiotensin-II Receptor Blockers and β-Adrenergic Blockers in Anthracycline- and Trastuzumab-Induced Cardiotoxicity. Cardiology in Review. 2019;27(5).
  12. Smith TA, Phyu SM, Akabuogu EU. Effects of Administered Cardioprotective Drugs on Treatment Response of Breast Cancer Cells. Anticancer research. 2016;36(1):87-93.
  13. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Jr., Drazner MH, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology. 2013;62(16):e147-239.
  14. Arciniegas Calle MC, Sandhu NP, Xia H, Cha SS, Pellikka PA, Ye Z, et al. Two-dimensional speckle tracking echocardiography predicts early subclinical cardiotoxicity associated with anthracycline-trastuzumab chemotherapy in patients with breast cancer. BMC Cancer. 2018;18(1):1037.
  15. Mihalcea DJ, Florescu M, Vinereanu D. Mechanisms and Genetic Susceptibility of Chemotherapy-Induced Cardiotoxicity in Patients With Breast Cancer. American journal of therapeutics. 2017;24(1):e3-e11.
  16. Cao L, Cai G, Chang C, Miao AY, Yu XL, Yang ZZ, et al. Diastolic Dysfunction Occurs Early in HER2-Positive Breast Cancer Patients Treated Concurrently With Radiation Therapy and Trastuzumab. The oncologist. 2015;20(6):605-14.
  17. Keramida K, Farmakis D, Bingcang J, Sulemane S, Sutherland S, Bingcang RA, et al. Longitudinal changes of right ventricular deformation mechanics during trastuzumab therapy in breast cancer patients. European Journal of Heart Failure. 2019;21(4):529-35.
  18. Otto CM. Textbook of Clinical Echocardiography. Philadelphia: Elsevier; 2018.
  19. 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). European heart journal. 2016;37(36):2768-801.
  20. Barish R, Gates E, Barac A. Trastuzumab-Induced Cardiomyopathy. Cardiology clinics. 2019;37(4):407-18.
  21. Nakano S, Takahashi M, Kimura F, Senoo T, Saeki T, Ueda S, et al. Cardiac magnetic resonance imaging-based myocardial strain study for evaluation of cardiotoxicity in breast cancer patients treated with trastuzumab: A pilot study to evaluate the feasibility of the method. Cardiology Journal. 2016;23(3):270-80.
Journal of Cardio-Thoracic Medicine
Volume 12, Issue 2
Spring 2024
Pages 1330-1336