Source: Mayo Clinic
Researchers at Mayo Clinic in Florida have developed a tool to help identify patients who may be at higher risk of developing heart damage from anti HER 2 breast cancer therapy at an early stage.
“Cardiac toxicity is a known complication of anti-HER 2 therapy,” says Pooja Advani, M.B.B.S., M.D., a Mayo Clinic oncologist. Dr. Advani says clinical studies have confirmed that the use of anti-HER 2 therapy in breast cancer patients can have a profound effect on patient survival.
“The most common manifestation of cardiac toxicity in breast cancer patients receiving anti-HER 2 therapy is a reduction in the ejection fraction without any symptoms,” says Dr. Advani. Ejection fraction is a measurement of the percentage of blood leaving the heart each time it contracts.
Dr. Advani says risk factors, such as older age; a lower ejection fraction prior to the start of treatment; and the use of anthracycline chemotherapy, such as doxorubin or Adriamycin, have been consistently associated with a higher risk of cardiac toxicity from anti-HER 2 therapy.
Dr. Advani and her colleagues followed 604 breast cancer patients who were treated with anti-HER 2 agents at Mayo Clinic. They collected patient data, including, age, race, gender, body mass index, smoking history, medical comorbidities, use of heart medications, baseline heart function, thickness of the heart muscle and prior use of anthracycline chemotherapy.
Researchers identified patients who developed cardiac toxicity — asymptomatic, symptomatic, or both. They performed a statistical analysis to identify risk factors that were associated with a high risk of developing cardiac dysfunction.
“We found that patients with certain risk factors including being over the age of 55, having a lower baseline heart function (ejection fraction less than 60 percent), having received anthracycline chemotherapy or patients having enlargement and thickening of the heart walls were most significantly associated with an increased risk of developing cardiac toxicity,” says Dr. Advani. “This is consistent with previously reported studies.”
Dr. Advani says patients receiving radiation therapy as a part of their breast cancer treatment were not found to be at a significantly higher risk of developing cardiac toxicity from anti-HER 2 therapy based on their findings.
Dr. Advani and her colleagues created a risk prediction model by assigning a score to each factor mentioned above and found that the cumulative risk score was a highly significant predictor of cardiac toxicity in patients.
“Using a risk prediction model at therapy initiation may help us identify patients who may benefit from an early referral to a cardiologist for close cardiac monitoring and treatment with medications to protect their heart function,” says Dr. Advani.
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