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Jung W, Cho IY, Jung J, Cho MH, Koo HY, Park YMM, Cho BL, Kwon H, Park JH, Han K, Shin DW. Association between physical activity changes and risk of incident ischemic stroke following cancer diagnosis: A nationwide retrospective cohort study. Cancer 2024; 130:2873-2885. [PMID: 38723109 DOI: 10.1002/cncr.35361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/27/2024] [Accepted: 04/19/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Physical inactivity is prevalent after cancer treatment, which could increase ischemic stroke risk in cancer survivors. This study investigated the association between physical activity change from pre- to post-diagnosis and ischemic stroke risk among cancer survivors. METHODS Using data from the Korean National Health Insurance Service database, 269,943 cancer survivors (mean [SD] age, 56.3 [12.1] years; 45.7% male) with no history of cardiovascular disease were evaluated based on changes in physical activity from pre- to post-diagnosis. Using the Fine-Gray model, subdistribution hazard ratios (sHRs) and 95% confidence intervals (CIs) for ischemic stroke risk were calculated, considering death as a competing risk. RESULTS After cancer diagnosis, 62.0% remained inactive, 10.1% remained active, 16.6% became active, and 11.4% became inactive. During a mean (SD) follow-up of 4.1 (2.0) years, being active both pre- and post-diagnosis was associated with a 15% decreased risk of ischemic stroke (sHR, 0.85; 95% CI, 0.75-0.96), compared with those who remained inactive. Cancer survivors who became active and inactive post-diagnosis showed a 16% and 11% lower ischemic stroke risk (sHR, 0.84; 95% CI, 0.75-0.93; sHR, 0.89; 95% CI, 0.79-0.99), respectively, than those who remained inactive. Analysis by the primary cancer site did not substantially differ from the main findings. CONCLUSIONS Physical activity is associated with reduced ischemic stroke risk among cancer survivors. The potential benefits of physical activity are not limited to individuals who were physically active before cancer diagnosis, thus preventive strategies against ischemic stroke should emphasize physical activity throughout the cancer journey.
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Affiliation(s)
- Wonyoung Jung
- Department of Family Medicine/Obesity and Metabolic Health Center, Kangdong Sacred Heart Hospital, Hallym University, Seoul, Republic of Korea
- Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - In Young Cho
- Department of Family Medicine and Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea
| | - Jinhyung Jung
- Department of Biostatistics, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Mi Hee Cho
- Samsung C&T Medical Clinic, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hye Yeon Koo
- Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yong-Moon Mark Park
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Be-Long Cho
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyuktae Kwon
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jin Ho Park
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Dong Wook Shin
- Department of Family Medicine and Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea
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Kambalapalli S, Baral N, Paul TK, Upreti P, Talaei F, Ayad S, Ibrahim M, Aggarwal V, Kumar G, Alraies C, Mitchell J. Thirty-day hospital readmission in females with acute heart failure and breast cancer: A retrospective cohort study from national readmission database. PLoS One 2024; 19:e0301596. [PMID: 39042606 PMCID: PMC11265691 DOI: 10.1371/journal.pone.0301596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 03/19/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Breast Cancer and cardiovascular diseases are amongst the two leading causes of mortality in the United States, and the two conditions are connected in part because of recognized cardiotoxicity of cancer treatments. The aim of this study is to investigate the predictors risk factors for thirty-day readmission in female breast cancer survivors presenting with acute heart failure. METHODS This is a retrospective cohort study of acute heart failure (AHF) hospitalization in female patients with breast cancer in 2019 using the National Readmission Database (NRD), which is the largest publicly available all-payer inpatient readmission database in the United States. Our study sample included adult female patients aged 18 years and older. The primary outcome of interest was the rate of 30- day readmission. RESULTS In 2019, there were 8332 total index admissions for AHF in females with breast cancer and 7776 patients were discharged alive. The mean age was 74.4 years (95% CI: 74, 74.7). The percentage of readmission at 30 days among those discharged alive was 21.8% (n = 1699). Hypertensive heart disease with chronic kidney disease accounted for the majority of readmission in AHF with breast cancer followed by sepsis, acute kidney injury, respiratory failure, pneumonia, and atrial fibrillation. Demographic factors including higher burden of comorbidities predict readmission. The total in-hospital mortality in index admission was 6.67% (n = 556) and for readmitted patients was 8.77% (n = 149). The mean length of stay for index admission was 7.5 days (95% CI: 7.25, 7.75). CONCLUSIONS Readmission of female breast cancer survivors presenting with AHF is common and largely be attributed to high burden of comorbidities including hypertension, and chronic kidney disease. A focus on close outpatient follow-up will be beneficial in lowering readmissions.
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Affiliation(s)
- Soumya Kambalapalli
- Department of Internal Medicine, McLaren Flint/Michigan State University College of Human Medicine, Flint, MI, United States of America
| | - Nischit Baral
- Department of Cardiology, Mount Sinai Medical Center Miami, Columbia University, Miami, Florida, United States of America
| | - Timir K. Paul
- Department of Cardiovascular Medicine, Ascension Saint Thomas Hospital, University of Tennessee College of Medicine, Nashville, Tennessee, United States of America
| | - Prakash Upreti
- Rochester General Hospital, Rochester, NY, United States of America
| | - Fahimeh Talaei
- Department of Internal Medicine, McLaren Flint/Michigan State University College of Human Medicine, Flint, MI, United States of America
| | - Sarah Ayad
- Department of Internal Medicine, Hurley Medical Center/Michigan State University College of Human Medicine, Flint, MI, United States of America
| | - Mahmoud Ibrahim
- Department of Internal Medicine, McLaren Flint/Michigan State University College of Human Medicine, Flint, MI, United States of America
| | - Vikas Aggarwal
- Division of Cardiology, University of Michigan, Ann Arbor, MI, United States of America
| | - Gautam Kumar
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Chadi Alraies
- Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, MI, United States of America
| | - Joshua Mitchell
- Division of Cardiology, Washington University, St. Louis, MO, United States of America
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Zhou S, Blaes A, Shenoy C, Sun J, Zhang R. Risk prediction of heart diseases in patients with breast cancer: A deep learning approach with longitudinal electronic health records data. iScience 2024; 27:110329. [PMID: 39055938 PMCID: PMC11269285 DOI: 10.1016/j.isci.2024.110329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/12/2024] [Accepted: 06/18/2024] [Indexed: 07/28/2024] Open
Abstract
Accurately predicting heart disease risks in patients with breast cancer is crucial for clinical decision support and patient safety. This study developed and evaluated predictive models for six heart diseases using real-world electronic health records (EHRs) data. We incorporated a trainable decay mechanism to handle missing values in the long short-term memory (LSTM) model, creating LSTM-D models to predict heart disease risk based on longitudinal EHRs data. Additionally, we deployed NLP methods to extract breast cancer phenotypes from clinical texts, integrating unstructured and structured data to enhance predictions. Our LSTM-D models outperformed baseline models in predicting congestive heart failure, coronary artery disease, cardiomyopathy, myocardial infarction, transient ischemic attack, and aortic regurgitation, with AUC scores ranging from 0.7189 to 0.9548. Observation windows of 12-24 months were found optimal for model performance. This research advances precise, personalized care strategies, enabling early intervention and improved management of cardiovascular risks in breast cancer survivors.
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Affiliation(s)
- Sicheng Zhou
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA
| | - Anne Blaes
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - Chetan Shenoy
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Ju Sun
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN, USA
| | - Rui Zhang
- Division of Computational Health Sciences, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
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Bostany G, Chen Y, Francisco L, Dai C, Meng Q, Sparks J, Sessions M, Nabell L, Stringer-Reasor E, Khoury K, Lenneman C, Keene K, Armenian S, Landier W, Bhatia S. Cardiac Dysfunction Among Breast Cancer Survivors: Role of Cardiotoxic Therapy and Cardiovascular Risk Factors. J Clin Oncol 2024:JCO2301779. [PMID: 38833638 DOI: 10.1200/jco.23.01779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 03/15/2024] [Accepted: 04/04/2024] [Indexed: 06/06/2024] Open
Abstract
PURPOSE Cardiac dysfunction is the leading cause of mortality among 10-year breast cancer survivors. Limited information regarding long-term risks of cardiac dysfunction after cardiotoxic therapy (anthracyclines, trastuzumab/pertuzumab, radiation) has precluded development of surveillance guidelines for the survivors. METHODS Patients with breast cancer who completed cardiotoxic therapy underwent echocardiographic screening every 2 years. New-onset cardiac dysfunction was defined as left ventricular ejection fraction (LVEF) <50% after cardiotoxic therapy initiation and included early- and late-onset cardiac dysfunction. RESULTS We evaluated 2,808 echocardiograms in 829 breast cancer survivors; the median age at breast cancer diagnosis was 54.2 years (range, 20.3-86.3); the median follow-up was 8.6 years (1.8-39.8); 39.7% received anthracyclines, 16% received trastuzumab/pertuzumab, 6.2% received both anthracyclines and trastuzumab/pertuzumab, and 38.1% received radiation alone. The cumulative incidence of cardiac dysfunction increased from 1.8% at 2 years to 15.3% at 15 years from cardiotoxic therapy initiation. Multivariable Cox regression analysis identified the following risk factors: non-Hispanic Black race (hazard ratio [HR], 2.15 [95% CI], 1.37 to 3.38), cardiotoxic therapies (anthracyclines: HR, 2.35 [95% CI, 1.25 to 4.4]; anthracyclines and trastuzumab/pertuzumab: HR, 3.92 [95% CI, 1.74 to 8.85]; reference: left breast radiation alone), selective estrogen receptor modulators (HR, 2.0 [95% CI, 1.2 to 3.33]), and precancer hypertension (HR, 3.16 [95% CI, 1.63 to 6.1]). Late-onset cardiac dysfunction was most prevalent among anthracycline- and radiation-exposed patients; early-onset cardiac dysfunction was most prevalent among patients exposed to anthracyclines and trastuzumab/pertuzumab; equal prevalence of both early- and late-onset cardiac dysfunction was observed in trastuzumab-/pertuzumab-exposed patients. Adjusted longitudinal analyses revealed an annual decline in LVEF by 0.29% (P = .009) over 20 years from breast cancer diagnosis. CONCLUSION These findings provide evidence to support echocardiographic surveillance for several years after cardiotoxic therapy and also suggest a need to examine the efficacy of management of cardiovascular risk factors to mitigate risk.
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Affiliation(s)
- Geoffrey Bostany
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham (UAB) Heersink School of Medicine (SOM), Birmingham, AL
| | - Yanjun Chen
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham (UAB) Heersink School of Medicine (SOM), Birmingham, AL
| | - Liton Francisco
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham (UAB) Heersink School of Medicine (SOM), Birmingham, AL
| | - Chen Dai
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham (UAB) Heersink School of Medicine (SOM), Birmingham, AL
| | - Qingrui Meng
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham (UAB) Heersink School of Medicine (SOM), Birmingham, AL
| | - Jessica Sparks
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham (UAB) Heersink School of Medicine (SOM), Birmingham, AL
| | - Min Sessions
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham (UAB) Heersink School of Medicine (SOM), Birmingham, AL
| | - Lisle Nabell
- Division of Hematology/Oncology, UAB, Birmingham, AL
| | | | - Katia Khoury
- Division of Hematology/Oncology, UAB, Birmingham, AL
| | | | | | - Saro Armenian
- Department of Pediatric Oncology, City of Hope, Duarte, CA
| | - Wendy Landier
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham (UAB) Heersink School of Medicine (SOM), Birmingham, AL
- Division of Pediatric Hematology/Oncology, UAB, Birmingham, AL
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham (UAB) Heersink School of Medicine (SOM), Birmingham, AL
- Division of Pediatric Hematology/Oncology, UAB, Birmingham, AL
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Izuegbuna OO, Olawumi HO, Agodirin OS, Olatoke SA. Lipid Profile and Atherogenic Risk Assessment in Nigerian Breast Cancer Patients - A Cross-Sectional Study. JOURNAL OF THE AMERICAN NUTRITION ASSOCIATION 2024:1-10. [PMID: 38805002 DOI: 10.1080/27697061.2024.2353289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 05/04/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND The lipid profile and atherogenic risk indices in Nigerian breast cancer patients are largely unknown. This study evaluated the lipid profile and atherogenic risk indices of breast cancer patients in Nigeria. METHODS This study involved 45 primarily diagnosed breast cancer patients and 50 normal control subjects. Total cholesterol, triglyceride, and High-density lipoprotein cholesterol (HDL-C) were measured. Low-density lipoprotein cholesterol (LDL-C) was calculated according to Friedewald formula. Atherogenic index of plasma (AIP), Atherogenic coefficient (AC), TC/HDL-C (Castelli I) and LDL-C/HDL-C (Castelli II) risk indices were all calculated. The Framingham risk assessment was calculated and categorized. RESULTS The study group had significantly higher triglycerides (TG), and atherogenic indices than the control group (p < 0.001), while HDL-Cholesterol (HDL-C) was significantly lower in the study group (p < 0.001). Total cholesterol and LDL-Cholesterol (LDL-C) had a significant positive correlation with age (r = 0.283, p < 0.018; r = 0.272, p < 0.023); TG was significantly positively correlated with systolic and diastolic blood pressure (r = 0.320. p < 0.007; r = 0.334, p < 0.005); HDL-C had a significant negative correlation with BMI, systolic and diastolic blood pressure (r = -0.252, p < 0.035; r = -0.29, p < 0.015; r = -0.329, p < 0.005). The lipid ratios (TC/HDL-C, LDL-C/HDL-C) were significantly positively correlated with body mass index (BMI), systolic and diastolic blood pressure. The Framingham Risk Score showed that only 2 subjects in the study group (4.4%) were at a high risk of having a cardiovascular event. CONCLUSION Breast cancer patients have a higher prevalence of dyslipidaemia, and cardiovascular risk than the normal population.
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Affiliation(s)
- Ogochukwu O Izuegbuna
- Department of Haematology and Blood Transfusion, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Hannah O Olawumi
- Department of Haematology and Blood Transfusion, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Olayide S Agodirin
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Samuel A Olatoke
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria
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Wadasadawala T, Joshi S, Rath S, Popat P, Sahay A, Gulia S, Bhargava P, Krishnamurthy R, Hoysal D, Shah J, Engineer M, Bajpai J, Kothari B, Pathak R, Jaiswal D, Desai S, Shet T, Patil A, Pai T, Haria P, Katdare A, Chauhan S, Siddique S, Vanmali V, Hawaldar R, Gupta S, Sarin R, Badwe R. Tata Memorial Centre Evidence Based Management of Breast cancer. Indian J Cancer 2024; 61:S52-S79. [PMID: 38424682 DOI: 10.4103/ijc.ijc_55_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 01/31/2024] [Indexed: 03/02/2024]
Abstract
ABSTRACT The incidence of breast cancer is increasing rapidly in urban India due to the changing lifestyle and exposure to risk factors. Diagnosis at an advanced stage and in younger women are the most concerning issues of breast cancer in India. Lack of awareness and social taboos related to cancer diagnosis make women feel hesitant to seek timely medical advice. As almost half of women develop breast cancer at an age younger than 50 years, breast cancer diagnosis poses a huge financial burden on the household and impacts the entire family. Moreover, inaccessibility, unaffordability, and high out-of-pocket expenditure make this situation grimmer. Women find it difficult to get quality cancer care closer to their homes and end up traveling long distances for seeking treatment. Significant differences in the cancer epidemiology compared to the west make the adoption of western breast cancer management guidelines challenging for Indian women. In this article, we intend to provide a comprehensive review of the management of breast cancer from diagnosis to treatment for both early and advanced stages from the perspective of low-middle-income countries. Starting with a brief introduction to epidemiology and guidelines for diagnostic modalities (imaging and pathology), treatment has been discussed for early breast cancer (EBC), locally advanced, and MBC. In-depth information on loco-regional and systemic therapy has been provided focusing on standard treatment protocols as well as scenarios where treatment can be de-escalated or escalated.
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Affiliation(s)
- Tabassum Wadasadawala
- Department of Radiation Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Shalaka Joshi
- Department of Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Sushmita Rath
- Department of Medical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Palak Popat
- Department of Radiology, Tata Memorial Centre and Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Ayushi Sahay
- Department of Pathology, Tata Memorial Centre and Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Seema Gulia
- Department of Medical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Prabhat Bhargava
- Department of Medical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Revathy Krishnamurthy
- Department of Radiation Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Dileep Hoysal
- Department of Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Jessicka Shah
- Department of Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Mitchelle Engineer
- Department of Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Jyoti Bajpai
- Department of Medical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Bhavika Kothari
- Department of Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Rima Pathak
- Department of Radiation Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Dushyant Jaiswal
- Department of Plastic Surgery, Tata Memorial Centre and Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Sangeeta Desai
- Department of Pathology, Tata Memorial Centre and Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Tanuja Shet
- Department of Pathology, Tata Memorial Centre and Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Asawari Patil
- Department of Pathology, Tata Memorial Centre and Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Trupti Pai
- Department of Pathology, Tata Memorial Centre and Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Purvi Haria
- Department of Radiology, Tata Memorial Centre and Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Aparna Katdare
- Department of Radiology, Tata Memorial Centre and Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Sonal Chauhan
- Department of Radiology, Tata Memorial Centre and Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Shabina Siddique
- Department of Clinical Research Secretariat, Tata Memorial Centre and Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Vaibhav Vanmali
- Department of Clinical Research Secretariat, Tata Memorial Centre and Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Rohini Hawaldar
- Department of Clinical Research Secretariat, Tata Memorial Centre and Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Rajiv Sarin
- Department of Radiation Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Rajendra Badwe
- Department of Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
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Slavcheva SE, Angelov A. HER2-Targeted Therapy-From Pathophysiology to Clinical Manifestation: A Narrative Review. J Cardiovasc Dev Dis 2023; 10:489. [PMID: 38132657 PMCID: PMC10743885 DOI: 10.3390/jcdd10120489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/27/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Abstract
Trastuzumab is the primary treatment for all stages of HER2-overexpressing breast cancer in patients. Though discovered over 20 years ago, trastuzumab-induced cardiotoxicity (TIC) remains a research topic in cardio-oncology. This review explores the pathophysiological basis of TIC and its clinical manifestations. Their understanding is paramount for early detection and cardioprotective treatment. Trastuzumab renders cardiomyocytes susceptible by inhibiting the cardioprotective NRG-1/HER2/HER4 signaling pathway. The drug acts on HER2-receptor-expressing cardiomyocytes, endothelium, and cardiac progenitor cells (see the Graphical Abstract). The activation of immune cells, fibroblasts, inflammation, and neurohormonal systems all contribute to the evolution of TIC. A substantial amount of research demonstrates that trastuzumab induces overt and subclinical left ventricular (LV) systolic failure. Data suggest the development of right ventricular damage, LV diastolic dysfunction, and heart failure with preserved ejection fraction. Further research is needed to define a chronological sequence of cardiac impairments to guide the proper timing of cardioprotection implementation.
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Affiliation(s)
- Svetoslava Elefterova Slavcheva
- First Department of Internal Diseases, EC Cardiology, Faculty of Medicine, Medical University “Prof. Dr. Paraskev Stoyanov”, 9000 Varna, Bulgaria;
- First Cardiology Clinic with Intensive Cardiology Activity, University Multiprofessional Hospital of Active Treatment “St. Marina”, 9000 Varna, Bulgaria
| | - Atanas Angelov
- First Department of Internal Diseases, EC Cardiology, Faculty of Medicine, Medical University “Prof. Dr. Paraskev Stoyanov”, 9000 Varna, Bulgaria;
- First Cardiology Clinic with Intensive Cardiology Activity, University Multiprofessional Hospital of Active Treatment “St. Marina”, 9000 Varna, Bulgaria
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Sutton AL, Felix AS, Wahl S, Franco RL, Leicht Z, Williams KP, Hundley WG, Sheppard VB. Racial disparities in treatment-related cardiovascular toxicities amongst women with breast cancer: a scoping review. J Cancer Surviv 2023; 17:1596-1605. [PMID: 35420375 DOI: 10.1007/s11764-022-01210-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 04/01/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Black women often experience poorer breast cancer-related outcomes and higher mortality than white women. A contributor to this disparity may relate to the disproportionate burden of cancer treatment-related cardiovascular (CV) toxicities. The objective of this review is to identify studies that report racial differences in CV toxicity risk. METHODS Medline and Embase were searched for studies that assessed CV toxicities as the outcome(s) and included Black and White women with breast cancer. Studies were selected based on inclusion/exclusion criteria and through the use of multiple reviewers. RESULTS The review included 13 studies following a review of 409 citations and 49 full-text articles. All studies were retrospective and 8/13 utilized data from the Surveillance, Epidemiology, and End Results-Medicare linked database. Trastuzumab was the most frequently studied treatment. The proportion of Black women in these studies ranged from 5.5 to 63%. A majority of studies reported a higher risk of CV toxicity amongst Black women when compared to white women (93%). Black women had up to a two times higher risk of CV toxicity (HR, 2.73 (CI, 1.24 to 6.01)) compared to white women. Only one study evaluated the role of socioeconomic factors in explaining racial differences in CV toxicity; however, the disparity remained even after adjusting for these factors. CONCLUSIONS There is a critical need for more longitudinal studies that evaluate multilevel factors (e.g., psychosocial, biological) that may help to explain this disparity. IMPLICATIONS FOR CANCER SURVIVORS Black cancer survivors may require additional surveillance and mitigation strategies to decrease disproportionate burden of CV toxicities.
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Affiliation(s)
- Arnethea L Sutton
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, P.O. Box 980149, Richmond, VA, 23219, USA.
| | - Ashley S Felix
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Stacey Wahl
- Health Sciences Library, Virginia Commonwealth University, Richmond, VA, USA
| | - R Lee Franco
- Department of Kinesiology and Health Sciences, College of Humanities and Sciences, Virginia Commonwealth University, Richmond, VA, USA
| | - Zachary Leicht
- Department of Kinesiology, School of Education and Human Development, University of Virginia, Charlottesvile, VA, USA
| | | | - W Gregory Hundley
- Pauley Heart Center, Virginia Commonwealth University Health Sciences, Richmond, VA, USA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, P.O. Box 980149, Richmond, VA, 23219, USA
- Office of Health Equity and Disparities Research, Massey Cancer Center, Richmond, VA, USA
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Wilbers A, Quinn KR, Okut H, Helmer SD, Tenofsky PL. Systemic Therapy in Elderly Patients With Her2/Neu-Positive Breast Cancer: A SEER Database Study. Am Surg 2023; 89:5690-5696. [PMID: 37132385 DOI: 10.1177/00031348231173993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND The use of systemic therapy in elderly patients with Her2/neu-positive breast cancers has been questioned given the potential for cardiac side effects with several of the agents frequently used. This study aimed to evaluate trends in use of systemic therapy in patients 70 years and older. METHODS The 2010-2016 SEER database was used to collect data on female patients with non-metastatic Her2/neu-positive breast cancer. Data was stratified to compare systemic therapy use in patients <70 vs ≥70. RESULTS A total of 62,014 patients were included in the study. Of those, 79.0% (38,760) of patients <70 years old received systemic therapy while only 45.2% (5844) of patients ≥70 received systemic therapy (P < .001). Of patients ≥70 with ER positive tumors, 42.1% received systemic therapy and those with ER negative tumors, 52.1% received systemic therapy. The mortality rate in patients ≥70 was 8.5% in those who received systemic therapy and 12.1% in those who did not (P < .001). CONCLUSIONS There remains a significant difference in rates of systemic therapy administration in the elderly population with an associated increase in mortality due to their cancer. Continuing educational efforts could be of benefit.
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Affiliation(s)
- Ashley Wilbers
- Department of Surgery, University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - Karson R Quinn
- Department of Surgery, University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - Hayrettin Okut
- Office of Research, University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - Stephen D Helmer
- Department of Surgery, University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - Patty L Tenofsky
- Department of Surgery, University of Kansas School of Medicine-Wichita, Wichita, KS, USA
- Department of Surgery, Ascension via Christi Clinic, Wichita, KS, USA
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10
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Murtagh G, Januzzi JL, Scherrer‐Crosbie M, Neilan TG, Dent S, Ho JE, Appadurai V, McDermott R, Akhter N. Circulating Cardiovascular Biomarkers in Cancer Therapeutics-Related Cardiotoxicity: Review of Critical Challenges, Solutions, and Future Directions. J Am Heart Assoc 2023; 12:e029574. [PMID: 37889193 PMCID: PMC10727390 DOI: 10.1161/jaha.123.029574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 09/26/2023] [Indexed: 10/28/2023]
Abstract
Cardiotoxicity is a growing concern in the oncology population. Transthoracic echocardiography and multigated acquisition scans have been used for surveillance but are relatively insensitive and resource intensive. Innovative imaging techniques are constrained by cost and availability. More sensitive, cost-effective cardiotoxicity surveillance strategies are needed. Circulating cardiovascular biomarkers could provide a sensitive, low-cost solution. Biomarkers such as troponins, natriuretic peptides (NPs), novel upstream signals of oxidative stress, inflammation, and fibrosis as well as panomic technologies have shown substantial promise, and guidelines recommend baseline measurement of troponins and NPs in all patients receiving potential cardiotoxins. Nonetheless, supporting evidence has been hampered by several limitations. Previous reviews have provided valuable perspectives on biomarkers in cancer populations, but important analytic aspects remain to be examined in depth. This review provides comprehensive assessment of critical challenges and solutions in this field, with focus on analytical issues relating to biomarker measurement and interpretation. Examination of evidence pertaining to common and serious forms of cardiotoxicity reveals that improved study designs incorporating larger, more diverse populations, registry-based approaches, and refinement of current definitions are key. Further efforts to harmonize biomarker methodologies including centralized biobanking and analyses, novel decision limits, and head-to-head comparisons are needed. Multimarker algorithms incorporating machine learning may allow rapid, personalized risk assessment. These improvements will not only augment the predictive value of circulating biomarkers in cardiotoxicity but may elucidate both direct and indirect relationships between cardiovascular disease and cancer, allowing biomarkers a greater role in the development and success of novel anticancer therapies.
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Affiliation(s)
| | - James L. Januzzi
- Division of Cardiology, Department of MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMAUSA
| | | | - Tomas G. Neilan
- Division of Cardiology, Department of MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMAUSA
| | - Susan Dent
- Duke Cancer Institute, Department of MedicineDuke UniversityDurhamNCUSA
| | - Jennifer E. Ho
- CardioVascular Institute and Division of Cardiology, Department of MedicineBeth Israel Deaconess Medicine CenterBostonMAUSA
| | - Vinesh Appadurai
- Division of Cardiovascular MedicineNorthwestern University Feinberg School of MedicineChicagoILUSA
- School of MedicineThe University of QueenslandSt LuciaQueenslandAustralia
| | - Ray McDermott
- Medical OncologySt. Vincent’s University HospitalDublinIreland
| | - Nausheen Akhter
- Division of Cardiovascular MedicineNorthwestern University Feinberg School of MedicineChicagoILUSA
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11
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Badheeb AM, Ahmed F, Alzahrani HA, Badheeb MA, Obied HY, Seada IA. Cancer Therapy-Related Cardiotoxicity: A Comprehensive Retrospective Analysis at Najran Cancer Center, Saudi Arabia. Cureus 2023; 15:e41287. [PMID: 37533611 PMCID: PMC10393428 DOI: 10.7759/cureus.41287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2023] [Indexed: 08/04/2023] Open
Abstract
Background Cardiotoxicity, produced as an adverse effect of anticancer therapy, is a common issue during cancer treatment. Acute coronary syndrome, myocarditis, arrhythmias, or heart failure can all be symptoms of this issue. Little is known about its occurrence among Saudi Arabian cancer patients. This study aims to investigate factors linked to anticancer therapy-related cardiotoxicity. Methods A retrospective study was conducted from April 2020 to May 2022 at the King Khalid Hospital, Najran, Saudi Arabia. The study included adult cancer patients receiving anticancer therapy, regardless of their cardiovascular disease history. Univariate analysis was used to investigate factors associated with the occurrence of cardiotoxicity related to anticancer therapy. Results Of 78 patients receiving anticancer therapy, cardiotoxicity occurred in 12 (15.4%) patients. The mean age was 56.5 ± 13.4 years, with 33.3% aged over 65 years. Comorbidities included hypertension (44; 56.4%), diabetes (41; 52.6%), dyslipidemia (13; 16.7%), smoking (16; 20.5%), heart disease (6; 7.7%), trastuzumab use (9; 11.5%), and chronic kidney disease (2; 2.6%). The most common cancers were breast cancer and gastrointestinal cancer (27.6% each). Monoclonal anticancer agents 35 (46.1%) and alkylating agents 29 (38.2%) were commonly used chemotherapies. Cardiac protective agents were used in 16 (21.1%) of patients, with angiotensin-converting enzyme (ACE) inhibitors 15 (19.7%) and statins (13; 17.1%) being the most prescribed. Baseline ejection fraction (EF) was normal in 69 (90.8%) of cases. The follow-up duration was 1.93 ± 1.90 years. A drop in EF occurred in five (6.6%) of cases. Dyslipidemia (OR: 0.12; 95% CI: 0.03-0.47, p=0.002), previous heart disease (OR: 0.14; 95% CI: 0.02-0.81, p=0.029), and impaired baseline EF (p=0.029) were associated with increased risk of cardiotoxicity. Statin (OR: 0.22; 95% CI: 0.05 to 0.84, p=0.028) and antiplatelet agents (OR: 0.19; 95% CI: 0.03 to 1.01, p=0.051) were protective agents against cardiac toxicity. Conclusion Effective anti-cancer therapy may be accompanied by an increased risk of cardiotoxicity. In this study, a history of prior heart disease, dyslipidemia, low baseline ejection fraction, and the administration of multiple anticancer therapy agents was associated with cardiotoxicity. Proactive management strategies aimed at mitigating the potential cardiotoxic effects of anti-cancer therapies are crucial.
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Affiliation(s)
- Ahmed M Badheeb
- Oncology, Oncology Center, King Khalid Hospital, Najran, SAU
| | | | | | - Mohamed A Badheeb
- Internal Medicine, Yale New Haven Health, Bridgeport Hospital, Bridgeport, USA
| | | | - Islam A Seada
- Extracorporeal Membrane Oxygenation (ECMO), ECMO Program, King Khalid Hospital, Najran, SAU
- Cardiothoracic Surgery, Mansoura University, Mansoura, EGY
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12
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Lini L, Rong X, Wei H, Xia G, Huayan X, Linjun X, Hongding Z, Gao J, Chao L, Yingkun G. Characteristics and research status among clinical trials in cardio-oncology by bibliometric and visualized analysis. Cancer Med 2023. [PMID: 37148538 DOI: 10.1002/cam4.6045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/20/2023] [Accepted: 04/23/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND We aim to establish the characteristics of published cardio-oncology research of clinical trials by bibliometric analysis and to talk about the prospects and difficulties facing the development of cardio-oncology. METHODS Search of data related to clinical trials in cardiac oncology from 1990 to 2022 from the Web of Science core collection. Using CiteSpace to perform co-citation analysis of authors, countries (regions) and institutions, journals and cited journals, cited authors and cited literature, and keywords. RESULTS Of the 607 clinical trial studies, the number of papers published per year has increased over time. The regions with the greatest influence were North America (especially the United States) and Europe. Multicenter research has always been the focus of cardio-oncology research, but cross-regional cooperation was still lacking. Myocardial toxicity caused by anthracyclines has received the earliest attention and has been studied for the longest time. Meanwhile, the efficacy and cardiotoxicity of new anticancer drugs always came into focus, but at a slow pace. Few studies on myocardial toxicity were related to the treatment of tumors except breast cancer. Risk factors, heart disease, adverse outcomes, follow-up, and intervention protection were the major hotspots revealed by co-citation cluster. CONCLUSIONS There is great potential for the development of clinical trials in cardio-oncology, especially in multicenter cooperation across different regions. Expansion of tumor types, myocardial toxicity of different drugs, and effective interventions in the research direction and design of clinical trials are necessary.
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Affiliation(s)
- Liu Lini
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xu Rong
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Huang Wei
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Guo Xia
- Department of Hematology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xu Huayan
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xie Linjun
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Zhang Hongding
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Ju Gao
- Department of Hematology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Lin Chao
- Department of Hematology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Guo Yingkun
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
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13
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Liu Y, Xu T, Vorobyeva A, Loftenius A, Bodenko V, Orlova A, Frejd FY, Tolmachev V. Radionuclide Therapy of HER2-Expressing Xenografts Using [ 177Lu]Lu-ABY-027 Affibody Molecule Alone and in Combination with Trastuzumab. Cancers (Basel) 2023; 15:cancers15092409. [PMID: 37173878 PMCID: PMC10177614 DOI: 10.3390/cancers15092409] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/16/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
ABY-027 is a scaffold-protein-based cancer-targeting agent. ABY-027 includes the second-generation Affibody molecule ZHER2:2891, which binds to human epidermal growth factor receptor type 2 (HER2). An engineered albumin-binding domain is fused to ZHER2:2891 to reduce renal uptake and increase bioavailability. The agent can be site-specifically labeled with a beta-emitting radionuclide 177Lu using a DOTA chelator. The goals of this study were to test the hypotheses that a targeted radionuclide therapy using [177Lu]Lu-ABY-027 could extend the survival of mice with HER2-expressing human xenografts and that co-treatment with [177Lu]Lu-ABY-027 and the HER2-targeting antibody trastuzumab could enhance this effect. Balb/C nu/nu mice bearing HER2-expressing SKOV-3 xenografts were used as in vivo models. A pre-injection of trastuzumab did not reduce the uptake of [177Lu]Lu-ABY-027 in tumors. Mice were treated with [177Lu]Lu-ABY-027 or trastuzumab as monotherapies and a combination of these therapies. Mice treated with vehicle or unlabeled ABY-027 were used as controls. Targeted monotherapy using [177Lu]Lu-ABY-027 improved the survival of mice and was more efficient than trastuzumab monotherapy. A combination of therapies utilizing [177Lu]Lu-ABY-027 and trastuzumab improved the treatment outcome in comparison with monotherapies using these agents. In conclusion, [177Lu]Lu-ABY-027 alone or in combination with trastuzumab could be a new potential agent for the treatment of HER2-expressing tumors.
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Affiliation(s)
- Yongsheng Liu
- Department of Immunology, Genetics and Pathology, Uppsala University, 751 85 Uppsala, Sweden
| | - Tianqi Xu
- Department of Immunology, Genetics and Pathology, Uppsala University, 751 85 Uppsala, Sweden
| | - Anzhelika Vorobyeva
- Department of Immunology, Genetics and Pathology, Uppsala University, 751 85 Uppsala, Sweden
| | | | - Vitalina Bodenko
- Research Centrum for Oncotheranostics, Research School of Chemistry and Applied Biomedical Sciences, Tomsk Polytechnic University, 634050 Tomsk, Russia
| | - Anna Orlova
- Department of Medicinal Chemistry, Uppsala University, 751 23 Uppsala, Sweden
| | - Fredrik Y Frejd
- Department of Immunology, Genetics and Pathology, Uppsala University, 751 85 Uppsala, Sweden
- Affibody AB, 171 65 Solna, Sweden
| | - Vladimir Tolmachev
- Department of Immunology, Genetics and Pathology, Uppsala University, 751 85 Uppsala, Sweden
- Research Centrum for Oncotheranostics, Research School of Chemistry and Applied Biomedical Sciences, Tomsk Polytechnic University, 634050 Tomsk, Russia
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14
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Yoon CI, Chang S, Park J, Kim D, Lee YJ, Bae SY, Park WC. Prediction of Cardiac Toxicity by Measurement of Coronary Artery Calcium Scoring Method Using Chest Computed Tomography in Early Breast Cancer Patients Treated with Trastuzumab. Breast Care (Basel) 2023; 18:22-30. [PMID: 36876165 PMCID: PMC9982350 DOI: 10.1159/000527683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
Background In human epidermal growth factor receptor 2 (HER2)-positive early stage breast cancer, prediction of trastuzumab-related cardiac toxicity remains a challenge. The coronary calcium artery (CAC) reflects the total coronary plaque burden, which predicts the risk of atherosclerosis. We investigated the prediction of left ventricular ejection fraction (LVEF) decline in breast cancer according to CAC scores. Methods A total of 347 patients were enrolled from Seoul St Mary's Hospital between January 2010 and December 2019. Chest computed tomography (CT) was performed at a single tertiary center. Patients who received trastuzumab for HER2-positive early breast cancer were included in this study. Results Of the 347 patients, 312 and 35 had CAC scores of 0 and ≥1, respectively. The CAC ≥1 group was associated with older age, body mass index, and receipt of left breast irradiation. The CAC ≥1 group was significantly associated with LVEF decline (absolute value, ≤50%) (hazard ratio [HR] 12.038, 95% confidence interval [CI] 2.845-50.937, p = 0.001), LVEF decline (absolute value, ≤55%) (HR 4.439, 95% CI: 1.787-11.028, p = 0.001), and decline in LVEF of ≥10% points compared with baseline echography (HR 5.083, 95% CI: 1.658-15.582, p = 0.004). Even after adjusting for other clinical factors, CAC ≥1 remained a significant predictor of decreased LVEF. Conclusion Our findings suggest that the CAC score is a significant predictor of cardiac toxicity following trastuzumab treatment in HER2-positive breast cancer. Therefore, CAC measurement could reduce cardiac toxicity by distinguishing patients at high risk for trastuzumab.
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Affiliation(s)
- Chang Ik Yoon
- Division of Breast Surgery, Department of Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Suyon Chang
- Department of Radiology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeaneum Park
- Department of Radiology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dooreh Kim
- Division of Breast Surgery, Department of Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Joo Lee
- Division of Breast Surgery, Department of Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soo Youn Bae
- Division of Breast Surgery, Department of Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Woo-Chan Park
- Division of Breast Surgery, Department of Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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15
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Teniente-Martínez G, Bernardino-Nicanor A, Valadez-Vega MDC, Montañez-Soto JL, Juárez-Goiz JMS, González-Cruz L. In vitro study of the antihypertensive, antioxidant and antiproliferative activities of peptides obtained from two varieties of Phaseolus coccineus L. CYTA - JOURNAL OF FOOD 2022. [DOI: 10.1080/19476337.2022.2090611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
| | - Aurea Bernardino-Nicanor
- Departamento de Ingeniería Bioquímica, Tecnológico Nacional de México-Celaya, Guanajuato, México
| | | | - José Luis Montañez-Soto
- Centro Interdisciplinario de Investigación para el Desarrollo Integral Regional del Instituto Politécnico Nacional, Unidad Michoacán, Michoacan, México
| | | | - Leopoldo González-Cruz
- Departamento de Ingeniería Bioquímica, Tecnológico Nacional de México-Celaya, Guanajuato, México
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16
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Jacquinot Q, Meneveau N, Falcoz A, Bouhaddi M, Roux P, Degano B, Chatot M, Curtit E, Mansi L, Paillard MJ, Bazan F, Chaigneau L, Dobi E, Meynard G, Vernerey D, Pivot X, Mougin F. Cardiotoxicity is mitigated after a supervised exercise program in HER2-positive breast cancer undergoing adjuvant trastuzumab. Front Cardiovasc Med 2022; 9:1000846. [PMID: 36211552 PMCID: PMC9537598 DOI: 10.3389/fcvm.2022.1000846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundTrastuzumab is used, alone or in conjunction with standard chemotherapy, to treat HER2-positive breast cancer (BC). Although it improves cancer outcomes, trastuzumab. can lead to cardiotoxicity. Physical exercise is a safe and effective supportive therapy in the management of side effects, but the cardioprotective effects of exercise are still unclear.ObjectivesThe primary aim of this study was to test whether trastuzumab-induced cardiotoxicity [left ventricular ejection fraction (LVEF) under 50%, or an absolute drop in LVEF of 10%] was reduced after a supervised exercise program of 3 months in patients with HER2-positive breast cancer. Secondary endpoints were to evaluate (i) cardiotoxicity rates using other criteria, (ii) cardiac parameters, (iii) cardiorespiratory fitness and (iv) whether a change in LVEF influences the cardiorespiratory fitness.Methods89 women were randomized to receive adjuvant trastuzumab in combination with a training program (training group: TG; n = 46) or trastuzumab alone (control group: CG; n = 43). The primary and secondary endpoints were evaluated at the end of the supervised exercise program of 3 months (T3).ResultsAfter exercise program, 90.5 % of TG patients and 81.8% of CG patients did not exhibit cardiotoxicity. Furthermore, whatever the used criterion, percentage of patients without cardiotoxicity were greater in TG (97.6 and 100% respectively) than in CG (90.9 and 93.9% respectively). LVEF and GLS values remained stable in both groups without any difference between the groups. In contrast, at T3, peak VO2 (+2.6 mL.min−1.kg−1; 95%CI, 1.8 to 3.4) and maximal power (+21.3 W; 95%CI, 17.3 to 25.3) increased significantly in TG, whereas they were unchanged in CG (peak VO2: +0.2 mL.min−1.kg−1; 95%CI, −0.5 to 0.9 and maximal power: +0.7 W, 95%CI, −3.6 to 5.1) compared to values measured at T0. No correlation between LVEF changes and peak VO2 or maximal power was observed.ConclusionA 12-week supervised exercise regimen was safe and improved the cardiopulmonary fitness in particular peak VO2, in HER2-positive BC patients treated with adjuvant trastuzumab therapy. The study is under powered to come to any conclusion regarding the effect on cardiotoxicity.Clinical trial registrationwww.ClinicalTrials.gov, identifier: NCT02433067.
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Affiliation(s)
- Quentin Jacquinot
- Regional Federative Cancer Institute of Franche-Comté, Besançon, France
- Research Unit EA3920, University of Franche-Comté, Besançon, France
- *Correspondence: Quentin Jacquinot
| | - Nathalie Meneveau
- Department of Medical Oncology, University Hospital, Besançon, France
| | - Antoine Falcoz
- UMR 1098, Methodology and Quality of Life Unit in Oncology, University Hospital, Besançon, France
| | - Malika Bouhaddi
- Research Unit EA3920, University of Franche-Comté, Besançon, France
- Physiology-Functional Explorations, University Hospital, Besançon, France
| | - Pauline Roux
- Physiology-Functional Explorations, University Hospital, Besançon, France
| | - Bruno Degano
- Heart-Lung Unit, Department of Physiology-Functional Explorations, University Hospital, Grenoble, France
| | - Marion Chatot
- Department of Cardiology, University Hospital, Besançon, France
| | - Elsa Curtit
- Department of Medical Oncology, University Hospital, Besançon, France
- INSERM UMR 1098, Host-Graft-Tumor Interaction, Cell and Gene Engineering, University of Franche-Comté, Besançon, France
| | - Laura Mansi
- Department of Medical Oncology, University Hospital, Besançon, France
- INSERM UMR 1098, Host-Graft-Tumor Interaction, Cell and Gene Engineering, University of Franche-Comté, Besançon, France
| | | | - Fernando Bazan
- Department of Medical Oncology, University Hospital, Besançon, France
| | - Loïc Chaigneau
- Department of Medical Oncology, University Hospital, Besançon, France
| | - Erion Dobi
- Department of Medical Oncology, University Hospital, Besançon, France
| | - Guillaume Meynard
- Department of Medical Oncology, University Hospital, Besançon, France
| | - Dewi Vernerey
- UMR 1098, Methodology and Quality of Life Unit in Oncology, University Hospital, Besançon, France
| | | | - Fabienne Mougin
- Research Unit EA3920, University of Franche-Comté, Besançon, France
- Sports Science Faculty, University of Franche-Comté, Besançon, France
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Abdel-Razeq H, Abu Rous F, Abuhijla F, Abdel-Razeq N, Edaily S. Breast Cancer in Geriatric Patients: Current Landscape and Future Prospects. Clin Interv Aging 2022; 17:1445-1460. [PMID: 36199974 PMCID: PMC9527811 DOI: 10.2147/cia.s365497] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/14/2022] [Indexed: 11/23/2022] Open
Abstract
Breast cancer is the most common cancer diagnosed among women worldwide and more than half are diagnosed above the age of 60 years. Life expectancy is increasing and the number of breast cancer cases diagnosed among older women are expected to increase. Undertreatment, mostly due to unjustifiable fears of advanced-age and associated comorbidities, is commonly practiced in this group of patients who are under-represented in clinical trials and their management is not properly addressed in clinical practice guidelines. With modern surgery and anesthesia, breast surgeries are considered safe and is usually associated with very low complication rates, regardless of extent of surgery. However, oncoplastic surgery and management of the axilla can be tailored based on patients’- and disease-related factors. Most of chemotherapeutic agents, along with targeted therapy and anti-Human epidermal growth factor receptor-2 (HER2) drugs can be safely given for older patients, however, dose adjustment and close monitoring of potential adverse events might be needed. The recently introduced cyclin-D kinase (CDK) 4/6-inhibitors in combination with aromatase inhibitors (AI) or fulvestrant, which changed the landscape of breast cancer therapy, are both safe and effective in older patients and had substituted more aggressive and potentially toxic interventions. Despite its proven efficacy, adjusting or even omitting adjuvant radiation therapy, at least in low-risk older patients, is safe and frequently practiced. In this paper, we review existing data related to breast cancer management among older patients across the continuum; from resection of the primary tumor through adjuvant chemotherapy, radiation and endocrine therapy up to the management of recurrent and advanced-stage disease.
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Affiliation(s)
- Hikmat Abdel-Razeq
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
- School of Medicine, The University of Jordan, Amman, Jordan
- Correspondence: Hikmat Abdel-Razeq, Department of Internal Medicine, King Hussein Cancer Center, 202 Queen Rania Al Abdullah Street, Amman, 11941, Jordan, Tel +962-6 5300460, Ext: 1000, Email
| | | | - Fawzi Abuhijla
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | | | - Sarah Edaily
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
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Cherukuri SP, Chikatimalla R, Dasaradhan T, Koneti J, Gadde S, Kalluru R. Breast Cancer and the Cardiovascular Disease: A Narrative Review. Cureus 2022; 14:e27917. [PMID: 36110451 PMCID: PMC9464354 DOI: 10.7759/cureus.27917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2022] [Indexed: 11/05/2022] Open
Abstract
Breast cancer is the most common malignancy affecting females worldwide and is also among the top causes of all cancer-related deaths. Cardiovascular disease (CVD) is known to have the highest rate of mortality in women. There are several risk factors for both CVD and breast cancer that overlap, such as diet, smoking, and obesity, and also the current breast cancer treatment has a significant detrimental effect on cardiovascular health in general. Patients with exposure to potentially cardiotoxic treatments, including anthracyclines, trastuzumab, and radiation therapy, are more likely to develop CVD than non-cancer controls. Early detection and treatment may reduce the risk of the development of cardiac morbidity and mortality and would increase the number of breast cancer survivors. This article provides a comprehensive overview of breast cancer, identifies shared risk factors among breast cancer and CVD, and the cardiotoxic effects of therapy. It also reviews possible prevention and treatment of CVD in breast cancer patients and reviews literature about chemoprevention of cardiac disease in the setting of breast cancer treatment.
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Koric A, Chang CP, Mark B, Rowe K, Snyder J, Dodson M, Deshmukh VG, Newman MG, Fraser AM, Smith KR, Date AP, Gren LH, Porucznik CA, Haaland BA, Henry NL, Hashibe M. Cardiovascular disease risk in long-term breast cancer survivors: A population-based cohort study. Cancer 2022; 128:2826-2835. [PMID: 35561317 PMCID: PMC9991862 DOI: 10.1002/cncr.34224] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/22/2022] [Accepted: 03/03/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Breast cancer survival is increasing, making late effects such as cardiovascular disease (CVD) more relevant. The purpose of this study was to evaluate incident CVD following breast cancer diagnosis among long-term survivors and to investigate possible risk factors for CVD. METHODS A population-based cohort of 6641 breast cancer survivors diagnosed between 1997 and 2009 who survived at least 10 years was identified within the Utah Cancer Registry. In addition, 36,612 cancer-free women from the general population, matched by birth year and state, were identified within the Utah Population Database. Cox proportional hazards models were used to calculate CVD hazard ratios (HRs) for >10 to 15 and >15 years. RESULTS Long-term breast cancer survivors had an increased risk of newly diagnosed diseases of the circulatory system (HR, 1.32; 99% confidence interval [CI], 1.00-1.75) from 10 to 15 years following cancer diagnosis compared with the general population. No increased CVD risks were observed after 15 years. Breast cancer survivors with Charlson Comorbidity Index score ≥2 had a significantly higher risk of diseases of the circulatory system (HR, 2.64; 95% CI, 1.08-6.45) beyond 10 years following breast cancer diagnosis. Similarly, older age, obesity, lower education, and family history of CVD and breast cancer were risk factors for heart and circulatory system diseases among long-term breast cancer survivors. CONCLUSION Risk of CVD compared to the general population was moderate among this cohort of long-term breast cancer survivors between 10 to 15 years since cancer diagnosis. Awareness of CVD risks is important for breast cancer survivors.
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Affiliation(s)
- Alzina Koric
- Huntsman Cancer Institute, Salt Lake City, Utah.,Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Chun-Pin Chang
- Huntsman Cancer Institute, Salt Lake City, Utah.,Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Bayarmaa Mark
- Huntsman Cancer Institute, Salt Lake City, Utah.,Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Kerry Rowe
- Intermountain Healthcare, Salt Lake City, Utah
| | - John Snyder
- Intermountain Healthcare, Salt Lake City, Utah
| | - Mark Dodson
- Intermountain Healthcare, Salt Lake City, Utah
| | | | - Michael G Newman
- Huntsman Cancer Institute, Salt Lake City, Utah.,University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Alison M Fraser
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Ken R Smith
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Ankita P Date
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Lisa H Gren
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Christina A Porucznik
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Benjamin A Haaland
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah
| | - N Lynn Henry
- Division of Hematology and Oncology, University of Michigan Medical School, University of Michigan Rogel Cancer Center, Ann Arbor, Michigan
| | - Mia Hashibe
- Huntsman Cancer Institute, Salt Lake City, Utah.,Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
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20
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Grigoriadis G, Sherman SR, Lima NS, Lefferts EC, Hibner BA, Ozemek HC, Danciu OC, Kanaloupitis D, Fernhall B, Baynard T. Breast cancer survivors with preserved or rescued cardiorespiratory fitness have similar cardiac, pulmonary and muscle function compared to controls. Eur J Appl Physiol 2022; 122:2189-2200. [PMID: 35796827 DOI: 10.1007/s00421-022-04992-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/16/2022] [Indexed: 11/29/2022]
Abstract
Breast cancer survivors (BCS) have a high prevalence of cardiovascular disease and low cardiorespiratory fitness (CRF). CRF is an important predictor of survival in BCS. However, the physiological factors that contribute to low CRF in BCS have not been completely elucidated. To assess differences in physiological factors (cardiac, pulmonary, muscle function) related to CRF between BCS and controls. Twenty-three BCS and 23 age-body mass index (BMI) matched controls underwent a peak cycling exercise test to determine CRF, with physiological factors measured at resting and at peak exercise. Cardiac hemodynamics (stroke volume [SV], SVindex, heart rate [HR], cardiac output [Formula: see text], and [Formula: see text]index) were evaluated using ultrasonography. Pulmonary function was evaluated using the oxygen uptake efficiency slope (OUES), ventilation to carbon dioxide production slope [Formula: see text] and breathing reserve at peak exercise (BR). Muscle oxygenation variables (oxygenated [HbO2] deoxygenated [HHb] and total hemoglobin [Hb], and tissue oxygenation index [TSI]) were measured with near-infrared spectroscopy (NIRS). Both groups had similar CRF and similarly increased all hemodynamic variables (HR, SV, SVindex, [Formula: see text] and [Formula: see text]index) at peak exercise compared to resting (p < 0.001). BCS had higher overall HR and lower SVindex (group effect, p < 0.05). BCS had similar OUES, [Formula: see text] and BR compared to the controls. Both groups decreased TSI, and increased Hb and HHb similarly at peak exercise compared to resting (p < 0.001). Our data suggest BCS do not exhibit differences in cardiac, pulmonary, or muscle function at peak exercise compared to controls, when both groups have similar CRF and physical activity.
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Affiliation(s)
- Georgios Grigoriadis
- Integrative Physiology Laboratory, Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA.
| | - Sara R Sherman
- Integrative Physiology Laboratory, Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Natalia S Lima
- Integrative Physiology Laboratory, Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Elizabeth C Lefferts
- Integrative Physiology Laboratory, Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Brooks A Hibner
- Integrative Physiology Laboratory, Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Hannah C Ozemek
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Oana C Danciu
- Department of Hematology and Oncology, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Bo Fernhall
- Integrative Physiology Laboratory, Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Tracy Baynard
- Integrative Physiology Laboratory, Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
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21
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Upshaw JN, Mohanty S, Rastogi A. Cardioprotection of High-Risk Individuals. Heart Fail Clin 2022; 18:385-402. [PMID: 35718414 PMCID: PMC10984350 DOI: 10.1016/j.hfc.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Targeting cardioprotective strategies to patients at the highest risk for cardiac events can help maximize therapeutic benefits. Dexrazoxane, liposomal formulations, continuous infusions, and neurohormonal antagonists may be useful for cardioprotection for anthracycline-treated patients at the highest risk for heart failure. Prevalent cardiovascular disease is a risk factor for cardiac events with many cancer therapies, including anthracyclines, anti-human-epidermal growth factor receptor-2 therapy, radiation, and BCR-Abl tyrosine kinase inhibitors, and may be a risk factor for cardiac events with other therapies. Although evidence for cardioprotective strategies is sparse for nonanthracycline therapies, optimizing cardiac risk factors and prevalent cardiovascular disease may improve outcomes.
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Affiliation(s)
- Jenica N Upshaw
- Division of Cardiology, Tufts Medical Center, 800 Washington St, Boston, MA 02111, USA.
| | - Sharanya Mohanty
- Division of Cardiology, Tufts Medical Center, 800 Washington St, Boston, MA 02111, USA
| | - Akash Rastogi
- Division of Cardiology, Tufts Medical Center, 800 Washington St, Boston, MA 02111, USA
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22
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Oroujeni M, Tano H, Vorobyeva A, Liu Y, Vorontsova O, Xu T, Westerlund K, Orlova A, Tolmachev V, Karlström AE. Affibody-Mediated PNA-Based Pretargeted Cotreatment Improves Survival of Trastuzumab-Treated Mice Bearing HER2-Expressing Xenografts. J Nucl Med 2022; 63:1046-1051. [PMID: 34711617 PMCID: PMC9258572 DOI: 10.2967/jnumed.121.262123] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 10/15/2021] [Indexed: 01/03/2023] Open
Abstract
Treatment of patients with human epidermal growth factor receptor 2 (HER2)-expressing tumors using the monoclonal antibody trastuzumab increases survival. The Affibody-based peptide nucleic acid (PNA)-mediated pretargeted radionuclide therapy has demonstrated efficacy against HER2-expressing xenografts in mice. Structural studies suggest that Affibody molecules and trastuzumab bind to different epitopes on HER2. The aim of this study was to test the hypothesis that a combination of PNA-mediated pretargeted radionuclide therapy and trastuzumab treatment of HER2-expressing xenografts can extend survival compared with monotherapies. Methods: Mutual interference of the primary pretargeting probe ZHER2:342-SR-HP1 and trastuzumab in binding to HER2-expressing cell lines was investigated in vitro. Experimental therapy evaluated the survival of mice bearing HER2-expressing SKOV-3 xenografts after treatment with vehicle, trastuzumab only, pretargeting using Affibody-PNA chimera ZHER2:342-SR-HP1 and complementary probe 177Lu-HP2, and combination of trastuzumab and pretargeting. The ethical permit limited the study to 90 d. The animals' weights were monitored during the study. After study termination, samples of liver and kidneys were evaluated by a veterinary pathologist for toxicity signs. Results: The presence of a large molar excess of trastuzumab had no influence on the affinity of ZHER2:342-SR-HP1 binding to HER2-expressing cells in vitro. The affinity of trastuzumab was not affected by a large excess of ZHER2:342-SR-HP1 The median survival of mice treated with trastuzumab (75.5 d) was significantly longer than the survival of mice treated with a vehicle (59.5 d). Median survival of mice treated with pretargeting was not reached by day 90. Six mice of 10 in this group survived, and 2 had complete remission. All mice in the combination treatment group survived, and tumors in 7 mice had disappeared at study termination. There was no significant difference between animal weights in the different treatment groups. No significant pathologic alterations were detected in livers and kidneys of treated animals. Conclusion: Treatment of mice bearing HER2-expressing xenografts with the combination of trastuzumab and Affibody-mediated PNA-based radionuclide pretargeting significantly increased survival compared with monotherapies. Cotreatment was not toxic for normal tissues.
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Affiliation(s)
- Maryam Oroujeni
- Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden
| | - Hanna Tano
- Department of Protein Science, School of Engineering Sciences in Chemistry, Biotechnology, and Health, KTH Royal Institute of Technology, AlbaNova University Center, Stockholm, Sweden
| | - Anzhelika Vorobyeva
- Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden;,Research Centrum for Oncotheranostics, Research School of Chemistry and Applied Biomedical Sciences, Tomsk Polytechnic University, Tomsk, Russia; and
| | - Yongsheng Liu
- Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden
| | - Olga Vorontsova
- Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden
| | - Tianqi Xu
- Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden
| | - Kristina Westerlund
- Department of Protein Science, School of Engineering Sciences in Chemistry, Biotechnology, and Health, KTH Royal Institute of Technology, AlbaNova University Center, Stockholm, Sweden
| | - Anna Orlova
- Research Centrum for Oncotheranostics, Research School of Chemistry and Applied Biomedical Sciences, Tomsk Polytechnic University, Tomsk, Russia; and,Department of Medicinal Chemistry, Uppsala University, Uppsala University, Uppsala, Sweden
| | - Vladimir Tolmachev
- Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden;,Research Centrum for Oncotheranostics, Research School of Chemistry and Applied Biomedical Sciences, Tomsk Polytechnic University, Tomsk, Russia; and
| | - Amelie Eriksson Karlström
- Department of Protein Science, School of Engineering Sciences in Chemistry, Biotechnology, and Health, KTH Royal Institute of Technology, AlbaNova University Center, Stockholm, Sweden
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23
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Neoadjuvant Trastuzumab and Pertuzumab for Early HER2-Positive Breast Cancer: A Real World Experience. Breast J 2022; 2022:7146172. [PMID: 35833190 PMCID: PMC9262537 DOI: 10.1155/2022/7146172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 02/22/2022] [Accepted: 05/26/2022] [Indexed: 11/18/2022]
Abstract
Background Randomized studies of neoadjuvant (NA) trastuzumab and pertuzumab combined with chemotherapy for HER2-positive breast cancers (BC) have reported pathological complete response (pCR) rates of 39 to 61%. This study aimed to determine the real-world efficacy and toxicity of NA trastuzumab and pertuzumab combined with chemotherapy in a UK tertiary referral cancer centre. Methods HER2-positive early BC patients given neoadjuvant chemotherapy with trastuzumab and pertuzumab between October 2016 and February 2018 at our tertiary referral cancer centre were identified via pharmacy records. Clinico-pathological information, treatment regimens, treatment-emergent toxicities, operative details, and pathological responses and outcomes were recorded. Results 78 female patients were identified; 2 had bilateral diseases and 48 of 78 (62%) were node positive at presentation. 55 of 80 (71%) tumours were ER-positive. PCR occurred in 37 of 78 (46.3%; 95% CI: 35.3–57.2%) patients. 14 of 23 (60.8%) patients with ER-negative tumours achieved pCR; 23 of 55 (41.8%) were ER-positive and 6 of 19 (31.6%) were ER-positive and PgR-positive. No cardiac toxicity was documented. Diarrhoea occurred in 53 of 72 (74%) patients. Grade 3–4 toxicity occurred in ≥2% patients. These were diarrhoea, fatigue, and infection. The Median follow up period was 45.2 months (95% CI 43.8–46.3) with 71 of 78 (91.0%) remaining disease-free and 72 of 78 (92.3%) alive. Estimated OS at 2 years 86% (95% CI: 75–99%). Conclusion This data confirms the efficacy of neoadjuvant chemotherapy combined with dual HER2 directed therapy. While no cardiac toxicity was observed, diarrhoea occurred frequently. The low pCR rate observed in ER and PgR-positive BCs warrants further investigation and consideration of strategies to increase the pCR rate.
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24
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Battisti NML, Welch CA, Sweeting M, de Belder M, Deanfield J, Weston C, Peake MD, Adlam D, Ring A. Prevalence of Cardiovascular Disease in Patients With Potentially Curable Malignancies. JACC CardioOncol 2022; 4:238-253. [PMID: 35818547 PMCID: PMC9270631 DOI: 10.1016/j.jaccao.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background Although a common challenge for patients and clinicians, there is little population-level evidence on the prevalence of cardiovascular disease (CVD) in individuals diagnosed with potentially curable cancer. Objectives We investigated CVD rates in patients with common potentially curable malignancies and evaluated the associations between patient and disease characteristics and CVD prevalence. Methods The study included cancer registry patients diagnosed in England with stage I to III breast cancer, stage I to III colon or rectal cancer, stage I to III prostate cancer, stage I to IIIA non-small-cell lung cancer, stage I to IV diffuse large B-cell lymphoma, and stage I to IV Hodgkin lymphoma from 2013 to 2018. Linked hospital records and national CVD databases were used to identify CVD. The rates of CVD were investigated according to tumor type, and associations between patient and disease characteristics and CVD prevalence were determined. Results Among the 634,240 patients included, 102,834 (16.2%) had prior CVD. Men, older patients, and those living in deprived areas had higher CVD rates. Prevalence was highest for non-small-cell lung cancer (36.1%) and lowest for breast cancer (7.7%). After adjustment for age, sex, the income domain of the Index of Multiple Deprivation, and Charlson comorbidity index, CVD remained higher in other tumor types compared to breast cancer patients. Conclusions There is a significant overlap between cancer and CVD burden. It is essential to consider CVD when evaluating national and international treatment patterns and cancer outcomes.
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25
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Zullig LL, Sung AD, Khouri MG, Jazowski S, Shah NP, Sitlinger A, Blalock DV, Whitney C, Kikuchi R, Bosworth HB, Crowley MJ, Goldstein KM, Klem I, Oeffinger KC, Dent S. Cardiometabolic Comorbidities in Cancer Survivors. JACC CardioOncol 2022; 4:149-165. [PMID: 35818559 PMCID: PMC9270612 DOI: 10.1016/j.jaccao.2022.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 03/16/2022] [Accepted: 03/18/2022] [Indexed: 12/28/2022] Open
Abstract
There are nearly 17 million cancer survivors in the United States, including those who are currently receiving cancer therapy with curative intent and expected to be long-term survivors, as well as those with chronic cancers such as metastatic disease or chronic lymphocytic leukemia, who will receive cancer therapy for many years. Current clinical practice guidelines focus on lifestyle interventions, such as exercise and healthy eating habits, but generally do not address management strategies for clinicians or strategies to increase adherence to medications. We discuss 3 cardiometabolic comorbidities among cancer survivors and present the prevalence of comorbidities prior to a cancer diagnosis, treatment of comorbidities during cancer therapy, and management considerations of comorbidities in long-term cancer survivors or those on chronic cancer therapy. Approaches to support medication adherence and potential methods to enhance a team approach to optimize care of the individual with cancer across the continuum of disease are discussed. Cancer survivors are at increased risk for several chronic conditions, including hypertension, dyslipidemia, and diabetes. Determining optimal management of comorbidities for patients with cancer is critical. A multidisciplinary care approach is recommended throughout the continuum of active cancer treatment and survivorship. Survivorship research should focus on medication adherence and coordination of care.
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Affiliation(s)
- Leah L. Zullig
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- Address for correspondence: Dr Leah Zullig, Duke University, 411 West Chapel Hill Street, Suite 600, Durham, North Carolina 27701, USA. @LeahZullig
| | - Anthony D. Sung
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Michel G. Khouri
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Shelley Jazowski
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Nishant P. Shah
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Andrea Sitlinger
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Dan V. Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
| | - Colette Whitney
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
- Cascades East–Oregon Health and Science University, Klamath Falls, Oregon, USA
| | - Robin Kikuchi
- Keck School of Medicine, University of California-Los Angeles, Los Angeles, California, USA
| | - Hayden B. Bosworth
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
| | - Matthew J. Crowley
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Karen M. Goldstein
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Igor Klem
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kevin C. Oeffinger
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Susan Dent
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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26
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New Insights on the Toxicity on Heart and Vessels of Breast Cancer Therapies. Med Sci (Basel) 2022; 10:medsci10020027. [PMID: 35736347 PMCID: PMC9229896 DOI: 10.3390/medsci10020027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 11/17/2022] Open
Abstract
Cardiovascular diseases are largely represented in patients with cancer and appear to be important side effects of cancer treatments, heavily affecting quality of life and leading to premature morbidity and death among cancer survivors. In particular, treatments for breast cancer have been shown to potentially play serious detrimental effects on cardiovascular health. This review aims to explore the available literature on breast cancer therapy-induced side effects on heart and vessels, illustrating the molecular mechanisms of cardiotoxicity known so far. Moreover, principles of cardiovascular risk assessment and management of cardiotoxicity in clinical practice will also be elucidated. Chemotherapy (anthracycline, taxanes, cyclophosphamide and 5-fluorouracil), hormonal therapy (estrogen receptor modulator and gonadotropin or luteinizing releasing hormone agonists) and targeted therapy (epidermal growth factor receptor 2 and Cyclin-dependent kinases 4 and 6 inhibitors) adverse events include arterial and pulmonary hypertension, supraventricular and ventricular arrhythmias, systolic and diastolic cardiac dysfunction and coronary artery diseases due to different and still not well-dissected molecular pathways. Therefore, cardiovascular prevention programs and treatment of cardiotoxicity appear to be crucial to improve morbidity and mortality of cancer survivors.
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27
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Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2022; 145:e895-e1032. [PMID: 35363499 DOI: 10.1161/cir.0000000000001063] [Citation(s) in RCA: 698] [Impact Index Per Article: 349.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AIM The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. METHODS A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. Structure: Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.
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Affiliation(s)
| | | | | | | | | | | | - Anita Deswal
- ACC/AHA Joint Committee on Clinical Practice Guidelines Liaison
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28
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Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary. J Am Coll Cardiol 2022; 79:1757-1780. [DOI: 10.1016/j.jacc.2021.12.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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29
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Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2022; 145:e876-e894. [PMID: 35363500 DOI: 10.1161/cir.0000000000001062] [Citation(s) in RCA: 146] [Impact Index Per Article: 73.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. METHODS A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. Structure: Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.
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Affiliation(s)
| | | | | | | | | | | | - Anita Deswal
- ACC/AHA Joint Committee on Clinical Practice Guidelines Liaison
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Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2022; 79:e263-e421. [PMID: 35379503 DOI: 10.1016/j.jacc.2021.12.012] [Citation(s) in RCA: 824] [Impact Index Per Article: 412.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. METHODS A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. STRUCTURE Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.
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Heidenreich PAULA, BOZKURT BIYKEM, AGUILAR DAVID, ALLEN LARRYA, BYUN JONIJ, COLVIN MONICAM, DESWAL ANITA, DRAZNER MARKH, DUNLAY SHANNONM, EVERS LINDAR, FANG JAMESC, FEDSON SAVITRIE, FONAROW GREGGC, HAYEK SALIMS, HERNANDEZ ADRIANF, KHAZANIE PRATEETI, KITTLESON MICHELLEM, LEE CHRISTOPHERS, LINK MARKS, MILANO CARMELOA, NNACHETA LORRAINEC, SANDHU ALEXANDERT, STEVENSON LYNNEWARNER, VARDENY ORLY, VEST AMANDAR, YANCY CLYDEW. 2022 American College of Cardiology/American Heart Association/Heart Failure Society of America Guideline for the Management of Heart Failure: Executive Summary. J Card Fail 2022; 28:810-830. [DOI: 10.1016/j.cardfail.2022.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Yang H, Bhoo Pathy N, Brand JS, Hedayati E, Grassmann F, Zeng E, Bergh J, Bian W, Ludvigsson JF, Hall P, Czene K. Risk of heart disease following treatment for breast cancer: results from a population-based cohort study. eLife 2022; 11:71562. [PMID: 35293856 PMCID: PMC8940173 DOI: 10.7554/elife.71562] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background: There is a rising concern about treatment-associated cardiotoxicities in breast cancer patients. This study aimed to determine the time- and treatment-specific incidence of arrhythmia, heart failure and ischemic heart disease in women diagnosed with breast cancer. Methods: A register-based matched cohort study was conducted including 8015 breast cancer patients diagnosed from 2001-2008 in the Stockholm-Gotland region and followed-up until 2017. Time-dependent risks of arrhythmia, heart failure and ischemic heart disease in breast cancer patients were assessed using flexible parametric models as compared to matched controls from general population. Treatment-specific effects were estimated in breast cancer patients using Cox model. Results: Time-dependent analyses revealed long-term increased risks of arrhythmia and heart failure following breast cancer diagnosis. Hazard ratios (HRs) within the first year of diagnosis were 2.14 (95% CI = 1.63-2.81) for arrhythmia and 2.71 (95% CI = 1.70-4.33) for heart failure. HR more than 10 years following diagnosis was 1.42 (95% CI = 1.21-1.67) for arrhythmia and 1.28 (95% CI = 1.03-1.59) for heart failure. The risk for ischemic heart disease was significantly increased only during the first year after diagnosis (HR=1.45, 95% CI = 1.03-2.04). Trastuzumab and anthracyclines were associated with increased risk of heart failure. Aromatase inhibitors, but not tamoxifen, were associated with risk of ischemic heart disease. No increased risk of heart disease was identified following loco-regional radiotherapy. Conclusions: Administration of systemic adjuvant therapies appears to be associated with increased risks of heart disease. The risk estimates observed in this study may aid adjuvant therapy decision-making and patient counseling in oncology practices. Funding: This work was supported by the Swedish Research Council [grant no: 2018-02547]; Swedish Cancer Society [grant no: CAN-19-0266] and FORTE [grant no: 2016-00081].
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Affiliation(s)
- Haomin Yang
- Department of Epidemiology and Health Statistics, Fujian Medical University, Fuzhou, China
| | - Nirmala Bhoo Pathy
- Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Judith S Brand
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Elham Hedayati
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Felix Grassmann
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Erwei Zeng
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Bergh
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Weiwei Bian
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Marinopoulos S, Dimitrakakis C, Kalampalikis A, Zagouri F, Andrikopoulou A, Rodolakis A. Adjuvant Treatment of Elderly Breast Cancer Patients: Offer the Best Chances of Cure. Breast Care (Basel) 2022; 17:71-80. [PMID: 35355693 PMCID: PMC8914240 DOI: 10.1159/000513708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 12/11/2020] [Indexed: 02/03/2023] Open
Abstract
Background Breast cancer remains the most common cancer in women and a leading cause of death. Elderly people have a higher incidence of breast cancer since it increases with age. Furthermore, the extended life expectancy and advances in imaging techniques have led to an increased number of cases. Guidelines concerning the management of this specific age group are rare, mainly due to underrepresentation of seniors in clinical trials. Moreover, increased frailty, comorbidities, and a poor performance status make it complex to determine the best therapeutic approach. Summary In this review, we attempt to summarize the current literature and aim to provide specific approaches and recommendations for prompt diagnosis, treatment, and management of breast cancer in the elderly. Key Messages The establishment of applicable protocols is imperative and efforts are being made in this direction. A careful geriatric assessment and adequate consultation should be the standard of care and patient's preferences should always be considered.
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Affiliation(s)
- Spyridon Marinopoulos
- Breast Unit, 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece,*Spyridon Marinopoulos, 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, 80 V. Sofias Ave., GR–11528 Athens (Greece),
| | - Constantine Dimitrakakis
- Breast Unit, 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | - Andreas Kalampalikis
- Breast Unit, 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | - Flora Zagouri
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | - Angeliki Andrikopoulou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | - Alexandros Rodolakis
- Breast Unit, 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
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Kwan ML, Cheng RK, Iribarren C, Neugebauer R, Rana JS, Nguyen-Huynh M, Shi Z, Laurent CA, Lee VS, Roh JM, Shen H, Rillamas-Sun E, Santiago-Torres M, Hershman DL, Kushi LH, Greenlee H. Risk of Cardiometabolic Risk Factors in Women With and Without a History of Breast Cancer: The Pathways Heart Study. J Clin Oncol 2022; 40:1635-1646. [PMID: 35025627 PMCID: PMC9113213 DOI: 10.1200/jco.21.01738] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE The incidence of cardiometabolic risk factors in breast cancer (BC) survivors has not been well described. Thus, we compared risk of hypertension, diabetes, and dyslipidemia in women with and without BC. METHODS Women with invasive BC diagnosed from 2005 to 2013 at Kaiser Permanente Northern California (KPNC) were identified and matched 1:5 to noncancer controls on birth year, race, and ethnicity. Cumulative incidence rates of hypertension, diabetes, and dyslipidemia were estimated with competing risk of overall death. Subdistribution hazard ratios (sHRs) were estimated by Fine and Gray regression, adjusted for cardiovascular disease-related risk factors, and stratified by treatment and body mass index (BMI). RESULTS A total of 14,942 BC cases and 74,702 matched controls were identified with mean age 61.2 years and 65% non-Hispanic White. Compared with controls, BC cases had higher cumulative incidence rates of hypertension (10.9% v 8.9%) and diabetes (2.1% v 1.7%) after 2 years, with higher diabetes incidence persisting after 10 years (9.3% v 8.8%). In multivariable models, cases had higher risk of diabetes (sHR, 1.16; 95% CI, 1.07 to 1.26) versus controls. Cases treated with chemotherapy (sHR, 1.23; 95% CI, 1.11 to 1.38), left-sided radiation (sHR, 1.29; 95% CI, 1.13 to 1.48), or endocrine therapy (sHR, 1.23; 95% CI, 1.12 to 1.34) continued to have higher diabetes risk. Hypertension risk was higher for cases receiving left-sided radiation (sHR, 1.11; 95% CI, 1.02 to 1.21) or endocrine therapy (sHR, 1.10; 95% CI, 1.03 to 1.16). Normal-weight (BMI < 24.9 kg/m2) cases had higher risks overall and within treatment subgroups versus controls. CONCLUSION BC survivors at KPNC experienced elevated risks of diabetes and hypertension compared with women without BC depending on treatments received and BMI. Future studies should examine strategies for cardiometabolic risk factor prevention in BC survivors.
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Affiliation(s)
- Marilyn L Kwan
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Richard K Cheng
- University of Washington School of Medicine, Seattle, WA.,Seattle Cancer Care Alliance, Seattle, WA, US
| | - Carlos Iribarren
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Romain Neugebauer
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Jamal S Rana
- Division of Research, Kaiser Permanente Northern California, Oakland, CA.,Oakland Medical Center, Kaiser Permanente Northern California, Oakland, CA
| | - Mai Nguyen-Huynh
- Division of Research, Kaiser Permanente Northern California, Oakland, CA.,Walnut Creek Medical Center, Kaiser Permanente Northern California, Walnut Creek, CA
| | - Zaixing Shi
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics and Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiamen, China.,Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Cecile A Laurent
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Valerie S Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Janise M Roh
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Hanjie Shen
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Eileen Rillamas-Sun
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Dawn L Hershman
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Heather Greenlee
- University of Washington School of Medicine, Seattle, WA.,Seattle Cancer Care Alliance, Seattle, WA, US.,Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
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Polychronopoulou E, Giordano SH, Chou LN, Yu X, Kuo YF. OUP accepted manuscript. Oncologist 2022; 27:434-440. [PMID: 35438771 PMCID: PMC9177105 DOI: 10.1093/oncolo/oyac059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 12/15/2021] [Indexed: 11/12/2022] Open
Abstract
Aim Methods Results Conclusions
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Affiliation(s)
- Efstathia Polychronopoulou
- Office of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA
- Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Sharon H Giordano
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lin-Na Chou
- Office of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA
- Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Xiaoying Yu
- Office of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA
- Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Yong-Fang Kuo
- Corresponding author: Yong-Fang Kuo, PhD, 700 Harborside Drive, Ewing Hall, 1.134, Galveston, TX 77555-1148, USA. Tel: +1 409 772 6355;
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36
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Park C, Park SK, Upshaw JN, Schonberg MA. In-hospital mortality, length of stay and hospital costs for hospitalized breast cancer patients with comorbid heart failure in the USA. Curr Med Res Opin 2021; 37:2043-2047. [PMID: 34525896 PMCID: PMC9627537 DOI: 10.1080/03007995.2021.1980775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/29/2021] [Accepted: 09/11/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Breast cancer and heart failure (HF) are frequently interconnected due to shared risk factors and the cardiotoxicity of breast cancer treatment. However, the association between HF and hospital outcomes among breast cancer patients has not been studied. This study examined the association between HF and hospital outcomes among hospitalized patients with breast cancer. METHODS This cross-sectional study using the 2015-2018 Healthcare Cost and Utilization Project-National Inpatient Sample data included hospitalized women who were aged 18 years or older and had a primary diagnosis code for breast cancer. Logistic regression, negative binomial regression, and generalized linear models with log-link and gamma distribution were used to assess the associations of HF with in-hospital mortality, length of stay (LOS) and hospital costs. RESULTS Among 17,335 hospitalized patients with breast cancer, 4.2% (n = 1021) had HF. Compared to breast cancer patients without HF, those with HF were more likely to die during hospitalization (odds ratio = 1.65, 95% CI = 1.27-2.16, p < .001), stay in the hospital longer (incidence rate ratio = 1.22, 95% CI = 1.15-1.30, p < .001) and have higher hospital costs (cost ratio = 1.09, 95% CI = 1.03-1.14, p = .003) during hospitalization, controlling for covariates. CONCLUSION HF has a substantial negative impact on health outcomes among hospitalized breast cancer patients. Breast cancer and HF are often considered separate medical conditions, but promoting effective management of comorbid HF in breast cancer patients may help to improve hospital outcomes in this population.
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Affiliation(s)
- Chanhyun Park
- Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, United States of America
| | - Sun-Kyeong Park
- School of Pharmacy, The Catholic University of Korea, Bucheon, South Korea
| | - Jenica N. Upshaw
- Division of Cardiology, Tufts Medical Center, Boston, MA, United States of America
| | - Mara A. Schonberg
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
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37
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Zullig LL, Shahsahebi M, Neely B, Hyslop T, Avecilla RAV, Griffin BM, Clayton-Stiglbauer K, Coles T, Owen L, Reeve BB, Shah K, Shelby RA, Sutton L, Dinan MA, Zafar SY, Shah NP, Dent S, Oeffinger KC. Low-touch, team-based care for co-morbidity management in cancer patients: the ONE TEAM randomized controlled trial. BMC FAMILY PRACTICE 2021; 22:234. [PMID: 34794388 PMCID: PMC8600877 DOI: 10.1186/s12875-021-01569-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/19/2021] [Indexed: 01/22/2023]
Abstract
Background As treatments for cancer have improved, more people are surviving cancer. However, compared to people without a history of cancer, cancer survivors are more likely to die of cardiovascular disease (CVD). Increased risk for CVD-related mortality among cancer survivors is partially due to lack of medication adherence and problems that exist in care coordination between cancer specialists, primary care physicians, and cardiologists. Methods/Design The Onco-primary care networking to support TEAM-based care (ONE TEAM) study is an 18-month cluster-randomized controlled trial with clustering at the primary care clinic level. ONE TEAM compares the provision of the iGuide intervention to patients and primary care providers versus an education-only control. For phase 1, at the patient level, the intervention includes video vignettes and a live webinar; provider-level interventions include electronic health records-based communication and case-based webinars. Participants will be enrolled from across North Carolina one of their first visits with a cancer specialist (e.g., surgeon, radiation or medical oncologist). We use a sequential multiple assignment randomized trial (SMART) design. Outcomes (measured at the patient level) will include Healthcare Effectiveness Data and Information Set (HEDIS) quality measures of management of three CVD comorbidities using laboratory testing (glycated hemoglobin [A1c], lipid profile) and blood pressure measurements; (2) medication adherence assessed pharmacy refill data using Proportion of Days Covered (PDC); and (3) patient-provider communication (Patient-Centered Communication in Cancer Care, PCC-Ca-36). Primary care clinics in the intervention arm will be considered non-responders if 90% or more of their participating patients do not meet the modified HEDIS quality metrics at the 6-month measurement, assessed once the first enrollee from each practice reaches the 12-month mark. Non-responders will be re-randomized to either continue to receive the iGuide 1 intervention, or to receive the iGuide 2 intervention, which includes tailored videos for participants and specialist consults with primary care providers. Discussion As the population of cancer survivors grows, ONE TEAM will contribute to closing the CVD outcomes gap among cancer survivors by optimizing and integrating cancer care and primary care teams. ONE TEAM is designed so that it will be possible for others to emulate and implement at scale. Trial registration This study (NCT04258813) was registered in clinicaltrals.gov on February 6, 2020.
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Affiliation(s)
- Leah L Zullig
- Department of Population Health Sciences, Duke University School Of Medicine, 215 Morris St, Durham, NC, 27701, USA. .,Department of Population Health Sciences, Duke University School of Medicine, 411 West Chapel Hill Street, Suite 600, Durham, NC, 27701, USA.
| | - Mohammad Shahsahebi
- Duke University Family Medicine and Community Health, 2424 Erwin Rd, Ste 601, DUMC, Box 2714, Durham, NC, 27705, USA.,Center for Onco-Primary Care, Duke Cancer Institute, 2424 Erwin Road, Hock Plaza, Ste 601, Durham, NC, 27705, USA
| | - Benjamin Neely
- Duke Cancer Institute, Duke University, 2424 Erwin Rd, Durham, NC, 27701, USA
| | - Terry Hyslop
- Department of Biostatistics, Duke University, 2424 Erwin Road, 9064 Hock Plaza, Durham, NC, 27705, USA
| | - Renee A V Avecilla
- Center for Onco-Primary Care, Duke Cancer Institute, 2424 Erwin Road, Hock Plaza, Ste 601, Durham, NC, 27705, USA
| | - Brittany M Griffin
- Center for Onco-Primary Care, Duke Cancer Institute, 2424 Erwin Road, Hock Plaza, Ste 601, Durham, NC, 27705, USA
| | - Kacey Clayton-Stiglbauer
- Center for Onco-Primary Care, Duke Cancer Institute, 2424 Erwin Road, Hock Plaza, Ste 601, Durham, NC, 27705, USA
| | - Theresa Coles
- Department of Population Health Sciences, Duke University School Of Medicine, 215 Morris St, Durham, NC, 27701, USA
| | - Lynda Owen
- Duke Cancer Network, 20 Duke Medicine Circle, Durham, NC, 27710, USA
| | - Bryce B Reeve
- Department of Population Health Sciences, Duke University School Of Medicine, 215 Morris St, Durham, NC, 27701, USA
| | - Kevin Shah
- Duke Institute for Health Innovation, Duke University Health System, 200 Morris St, Durham, NC, 27701, USA
| | - Rebecca A Shelby
- Duke Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2200 W. Main St, Ste 340, Durham, NC, 27705, USA
| | - Linda Sutton
- Duke Cancer Network, 20 Duke Medicine Circle, Durham, NC, 27710, USA
| | - Michaela A Dinan
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06510, USA
| | - S Yousuf Zafar
- Duke University School of Medicine, 2200 W. Main St, Ste 340, Durham, NC, 27705, USA
| | - Nishant P Shah
- Duke Heart Center, Duke University School of Medicine, 2200 W. Main St, Ste 340, Durham, NC, 27705, USA
| | - Susan Dent
- Duke Cancer Institute, Duke University, 2200 W. Main St, Ste 340, Durham, NC, 27705, USA
| | - Kevin C Oeffinger
- Duke Cancer Institute, Duke University School of Medicine, 2200 W. Main St, Ste 340, Durham, NC, 27705, USA
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Heart Failure Therapies for the Prevention of HER2-Monoclonal Antibody-Mediated Cardiotoxicity: A Systematic Review and Meta-Analysis of Randomized Trials. Cancers (Basel) 2021; 13:cancers13215527. [PMID: 34771689 PMCID: PMC8583665 DOI: 10.3390/cancers13215527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/30/2021] [Accepted: 11/01/2021] [Indexed: 12/11/2022] Open
Abstract
Simple Summary Monoclonal antibodies targeting HER2 are used for the management of early and metastatic HER2-positive breast cancer. Approximately 10–15% of patients diagnosed with breast cancer will be HER2-positive. The incidence of heart failure in breast cancer patients is becoming increasingly problematic, owing to the ageing of the population and the growing number of cancer survivors. The aim of our review was to assess the published evidence for the use of cardio-prevention strategies in HER2-monoclonal antibody-mediated cardiotoxicity. Whilst in the assessed trials the use of heart failure therapies did not reduce the risk of trastuzumab-associated cardiotoxicity, there was a reduction in the mean change in LVEF and in the rates of interruptions to HER2 therapy in patients treated with beta-blockers. This highlights the possible applications for neurohormonal therapies to prevent cardiotoxicity and mitigate interruption to vital HER2-monoclonal antibody treatment. Abstract Monoclonal antibodies including trastuzumab, pertuzumab, and antibody-drug conjugates, form the backbone of HER2-positive breast cancer therapy. Unfortunately, an important adverse effect of these agents is cardiotoxicity, occurring in approximately 10% of patients. There is increasing published data regarding prevention strategies for cardiotoxicity, though seldom used in clinical practice. We performed a systematic review and meta-analysis of randomized-controlled trials to evaluate pharmacotherapy for the prevention of monoclonal HER2-directed antibody-induced cardiotoxicity in patients with breast cancer. Online databases were queried from their inception until October 2021. Effects were determined by calculating risk ratios (RRs) and 95% confidence intervals (CI) or mean differences (MD) using random-effects models. We identified five eligible trials. In the three trials (n = 952) reporting data on the primary outcome of cardiotoxicity, there was no clear effect for patients assigned active treatment compared to control (RR = 0.90, 95% CI 0.63 to 1.29, p = 0.57). Effects were similar for ACE-I/ARB and beta-blockers (p homogeneity = 0.50). Active treatment reduced the risk of HER2 therapy interruptions (RR = 0.57, 95% CI 0.43 to 0.77, p < 0.001) with similar findings for ACE-I/ARB and beta-blockers (p homogeneity = 0.97). Prophylactic treatment with ACE-I/ARB or beta-blocker therapy may be of value for cardio-protection in patients with breast cancer prescribed monoclonal antibodies. Further, adequately powered randomized trials are required to define the role of routine prophylactic treatment in this patient group.
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Tini G, Ameri P, Buzzatti G, Sarocchi M, Murialdo R, Guglielmi G, Arboscello E, Ballestrero A, Del Mastro L, Spallarossa P, Porto I. Diversity of Cardiologic Issues in a Contemporary Cohort of Women With Breast Cancer. Front Cardiovasc Med 2021; 8:654728. [PMID: 34660706 PMCID: PMC8517118 DOI: 10.3389/fcvm.2021.654728] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 09/10/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Women with breast cancer (BC) represent a special population particularly exposed to cardiovascular disease (CVD) risk. However, cardiologic assessment in BC is mostly limited to detection of left ventricular dysfunction cardiotoxicity (LVD-CTX) due to anticancer treatments. Our aim was to comprehensively investigate CV profile and events in a contemporary BC cohort. Methods and Results: Records of BC patients referred for a Cardio-Oncologic evaluation before starting anticancer treatments, between 2016 and 2019, were retrospectively reviewed (n = 508). Information regarding prevalence and control of CV risk factors, and novel CVD diagnoses were extracted. Occurrence of LVD-CTX, CV events other than LVD-CTX and mortality was assessed. Mean age of study population was 64 ± 13 years; 287 patients were scheduled to receive anthracycline and 165 anti-HER2 therapy. Overall, 53% of BC women had ≥2 CV risk factors, and 67% had at least one of arterial hypertension, dyslipidaemia or diabetes mellitus not adequately controlled. Eighteen (4%) patients were diagnosed a previously unknown CVD. Over a mean follow-up of 2.5 ± 1 years, 3% of BC patients developed LVD-CTX, 2% suffered from other CV events and 11% died. CV risk factors were not associated with LVD-CTX, except for family history of CAD. On the contrary, patients with other CV events exhibited a worse CV profile. Those who died more commonly experienced CV events other than LVD-CTX (p = 0.02). Conclusions: BC women show a suboptimal CV risk profile and are at risk of CV events not limited to LVD-CTX. A baseline Cardio-Oncologic evaluation was instrumental to implement CV prevention and to optimize CV therapies.
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Affiliation(s)
- Giacomo Tini
- Cardiovascular Disease Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - Pietro Ameri
- Cardiovascular Disease Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - Giulia Buzzatti
- Breast Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy
| | - Matteo Sarocchi
- Cardiovascular Disease Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy
| | - Roberto Murialdo
- Internal Medicine Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy
| | - Giulia Guglielmi
- Cardiovascular Disease Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - Eleonora Arboscello
- Department of Emergency, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy
| | - Alberto Ballestrero
- Department of Internal Medicine, University of Genova, Genova, Italy
- Internal Medicine Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy
| | - Lucia Del Mastro
- Department of Internal Medicine, University of Genova, Genova, Italy
- Breast Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy
| | - Paolo Spallarossa
- Cardiovascular Disease Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy
| | - Italo Porto
- Cardiovascular Disease Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine, University of Genova, Genova, Italy
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Treatment and outcomes of older versus younger women with HER2-positive metastatic breast cancer in the real-world national ESME database. Breast 2021; 60:138-146. [PMID: 34624756 PMCID: PMC8503567 DOI: 10.1016/j.breast.2021.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 09/06/2021] [Accepted: 09/18/2021] [Indexed: 12/19/2022] Open
Abstract
Background Treatment and outcomes of patients with HER2-positive (HER2+) metastatic breast cancer (MBC) have dramatically improved over the past 20 years. This work evaluated treatment patterns and outcomes according to age. Methods Women who initiated a treatment for HER2+ MBC between 2008 and 2016 in one of the 18 French comprehensive centers part of the ESME program were included. Objectives were the description of first-line treatment patterns, overall survival (OS), first-line progression-free survival (PFS), and prognostic factors among patients aged 70 years or more (70+), or less than 70 (<70). Results Of 4045 women diagnosed with an HER2+ MBC, 814 (20%) were 70+. Standard first-line treatment (chemotherapy combined with an anti-HER2 therapy) was prescribed in 65% of 70+ versus 89% of <70 patients (p < 0.01). Median OS was 49.2 (95% CI, 47.1–52.4), 35.3 (95% CI, 31.5–37.0) and 54.2 months (95% CI, 50.8–55.7) in the whole population, in patients 70+ and <70, respectively. Corresponding median PFS1 were 12.8 (95% CI, 12.3–13.3), 11.1 (95% CI, 10.0–12.3) and 13.2 months (95% CI, 12.7–13.9), respectively. In 70+ women, initiation of non-standard first-line treatment had an independent detrimental time-varying effect on both OS and PFS (HR on OS at 1 year: chemotherapy without anti-HER2 2.79 [95% CI: 2.05–3.79]; endocrine therapy and/or anti-HER2 1.96 [95% CI: 1.43–2.69]). Conclusions In this large retrospective real-life database, older women with HER2+ MBC received standard first-line treatment less frequently than younger ones. This was independently associated with a worse outcome, but confounding factors and usual selection biases cannot be ruled out. Only 65% of women aged 70+ with HER2+ MBC receive a standard first-line treatment. Median PFS1 of women 70+ with HER2+ MBC is 11.1 months (95% CI, 10.0–12.3) vs 13.2 (95% CI, 12.7–13.9) for younger ones. Non-standard first-line treatment has a detrimental time-varying effect on both OS and PFS.
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Battisti NML, Joshi K, Nasser MS, Ring A. Systemic therapy for older patients with early breast cancer. Cancer Treat Rev 2021; 100:102292. [PMID: 34536728 DOI: 10.1016/j.ctrv.2021.102292] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/07/2021] [Indexed: 12/16/2022]
Abstract
Over a third of breast cancers are diagnosed in patients ≥70 years. With the ageing of the population, the number of older breast cancer patients will continue to rise. Older patients are under-represented in clinical studies underpinning breast cancer therapy, and frequently do not receive guideline-concordant care. This review outlines the evidence on the efficacy and the safety of systemic treatment options for the management of early-stage breast cancer (EBC) in older adults and identifies where critical data gaps exist. Chemotherapy is beneficial for older patients with oestrogen receptor (ER)-negative EBC, whilst the benefit for those with ER-positive disease is less certain. Careful consideration should be given to the side-effect profile of the treatment regimen chosen, owing to the risks of myelosuppression and cardiac damage, as well as toxicities, such as neuropathy, that may impact independence. The impact of chemotherapy on quality of life (QOL) outcomes appears significant but reversible in this population. Gene expression profiling, benefit and chemotherapy toxicity prediction tools integrating global health considerations hold promise to better inform chemotherapy decisions in this population. Benefits on targeted anti-human epidermal growth factor receptor 2 (HER2) agents is maintained in older EBC patients with a favourable safety profile. Endocrine therapy including aromatase inhibitors is the standard of care in this population, and extended treatment decisions should consider effects on bone health and life expectancy. More trials recruiting older adults with pragmatic designs and meaningful endpoints for this population are warranted to better inform systemic treatment decisions and discussion with patients.
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Affiliation(s)
- Nicolò Matteo Luca Battisti
- Department of Medicine - Breast Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, United Kingdom; Breast Cancer Research Division, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London SM2 5NG, United Kingdom.
| | - Kroopa Joshi
- Department of Medicine - Breast Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, United Kingdom.
| | - Mariam Syeda Nasser
- Department of Medicine - Breast Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, United Kingdom.
| | - Alistair Ring
- Department of Medicine - Breast Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, United Kingdom.
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Singh JC, Lichtman SM. Targeted Agents for HER2-Positive Breast Cancer: Optimal Use in Older Patients. Drugs Aging 2021; 38:829-844. [PMID: 34423398 DOI: 10.1007/s40266-021-00889-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2021] [Indexed: 10/20/2022]
Abstract
The human epidermal growth factor-2 (HER2) gene is overexpressed in 15-20 % of all breast cancers. HER2 overexpression is a predictive factor in breast cancer and is associated with high rates of disease recurrence and death in the absence of adjuvant systemic therapy. With the advent of HER2-directed therapies, there has been a significant improvement in the outcome of HER2-positive (HER2+) breast cancer in all clinical settings. Patients aged > 65 years remain under-represented in most clinical trials. Existing literature suggests that older patients with HER2+ disease derive a similar benefit from anti-HER2 therapies as do their younger counterparts, in both adjuvant and metastatic settings. Cardiotoxicity from HER2-directed therapy is a major concern with older patients, especially in the setting of pre-existing co-morbidities. Older patients need a geriatric assessment before beginning any systemic therapy, to identify patients predisposed to developing toxicity and to plan therapy. Many onco-geriatric tools have been developed to further identify frail patients. In this article, we discuss the most up-to-date clinical data on existing therapies for HER2+ breast cancer in adjuvant, neoadjuvant, and metastatic settings, and their application in older patients. We attempt to highlight clinical benefits and toxicities in this group that may aid clinicians in therapeutic decision making.
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Affiliation(s)
| | - Stuart M Lichtman
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, 10065, USA
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Sachpekidis C, Sachpekidis V, Kopp-Schneider A, Arsos G, Moralidis E. Equilibrium radionuclide angiography: Intra- and inter-observer repeatability and reproducibility in the assessment of cardiac systolic and diastolic function. J Nucl Cardiol 2021; 28:1304-1314. [PMID: 31385225 DOI: 10.1007/s12350-019-01830-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND This study aimed to assess intra- and inter-observer agreement in assessing the systolic and diastolic function with equilibrium radionuclide angiography (ERNA). MATERIALS AND METHODS Thirty-two adults underwent baseline and repeat ERNA. An experienced and a trainee operator analyzed the data by assigning regions of interest manually, fully automatically, and semi-automatically. The Bland-Altman statistic (mean ± 1.96 standard deviations of the differences) was used to assess the repeatability (two different assessments of a single acquisition) and reproducibility (assessments of two different acquisitions). RESULTS Using the semi-automated technique the intraobserver repeatability and reproducibility of left ventricular ejection fraction for the experienced physician were - 0.1 ± 3.7 and 0.0 ± 3.8 and for the trainee 2.2 ± 10.6 and 1.9 ± 8.4, respectively. The inter-observer repeatability and reproducibility were - 1.8 ± 6.4 and 0.4 ± 9.0, respectively. Among the parameters of diastolic function, the intraobserver repeatability and reproducibility of the peak filling rate for the experienced physician were - 0.0 ± 1.1 and - 0.1 ± 1.1 and for the trainee 0.2 ± 3.5 and 0.4 ± 3.7, respectively. The inter-observer repeatability and reproducibility were 0.3 ± 1.5 and 0.5 ± 4.0, respectively. Similar was the pattern for the other diastolic indices. In all cases the limits of agreement varied according to the quantification approach. CONCLUSION A good repeatability but a moderate reproducibility was found in the assessment of the LVEF. Less good were the findings in the assessment of diastolic function.
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Affiliation(s)
- Christos Sachpekidis
- Department of Nuclear Medicine, Papageorgiou Hospital, Aristotle University, Ring Road, Nea Efkarpia, 56429, Thessaloniki, Greece
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | - George Arsos
- Department of Nuclear Medicine, Papageorgiou Hospital, Aristotle University, Ring Road, Nea Efkarpia, 56429, Thessaloniki, Greece
| | - Efstratios Moralidis
- Department of Nuclear Medicine, Papageorgiou Hospital, Aristotle University, Ring Road, Nea Efkarpia, 56429, Thessaloniki, Greece.
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Dempsey N, Rosenthal A, Dabas N, Kropotova Y, Lippman M, Bishopric NH. Trastuzumab-induced cardiotoxicity: a review of clinical risk factors, pharmacologic prevention, and cardiotoxicity of other HER2-directed therapies. Breast Cancer Res Treat 2021; 188:21-36. [PMID: 34115243 DOI: 10.1007/s10549-021-06280-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/28/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE Despite great success as a targeted breast cancer therapy, trastuzumab use may be complicated by heart failure and loss of left ventricular contractile function. This review summarizes the risk factors, imaging, and prevention of cardiotoxicity associated with trastuzumab and other HER2-targeted therapies. FINDINGS Cardiovascular disease risk factors, advanced age, and previous anthracycline treatment predispose to trastuzumab-induced cardiotoxicity (TIC), with anthracycline exposure being the most significant risk factor. Cardiac biomarkers such as troponins and pro-BNP and imaging assessments such as echocardiogram before and during trastuzumab therapy may help in early identification of TIC. Initiation of beta-adrenergic antagonists and angiotensin converting enzyme inhibitors may prevent TIC. Cardiotoxicity rates of other HER2-targeted treatments, such as pertuzumab, T-DM1, lapatinib, neratinib, tucatinib, trastuzumab deruxtecan, and margetuximab, appear to be significantly lower as reported in the pivotal trials which led to their approval. CONCLUSIONS Risk assessment for TIC should include cardiac imaging assessment and should incorporate prior anthracycline use, the strongest risk factor for TIC. Screening and prediction of cardiotoxicity, referral to a cardio-oncology specialist, and initiation of effective prophylactic therapy may all improve prognosis in patients receiving HER2-directed therapy. Beta blockers and ACE inhibitors appear to mitigate risk of TIC. Anthracycline-free regimens have been proven to be efficacious in early HER2-positive breast cancer and should now be considered the standard of care for early HER2-positive breast cancer. Newer HER2-directed therapies appear to have significantly lower cardiotoxicity compared to trastuzumab, but trials are needed in patients who have experienced TIC and patients with pre-existing cardiac dysfunction.
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Affiliation(s)
- Naomi Dempsey
- Divisions of Medical Oncology, Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA.
| | - Amanda Rosenthal
- Divisions of Medical Oncology, Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA.,Department of Medicine, Kaiser Permanente Los Angeles Medical Center, 4867 Sunset Blvd, Los Angeles, CA, 90027, USA
| | - Nitika Dabas
- Divisions of Cardiology, Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Yana Kropotova
- Divisions of Medical Oncology, Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Marc Lippman
- Divisions of Medical Oncology, Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA.,Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, 3970 Reservoir Rd NW, Washington, DC, 20007, USA
| | - Nanette H Bishopric
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, 3970 Reservoir Rd NW, Washington, DC, 20007, USA.,MedStar Heart Research Institute, MedStar Washington Hospital Center, 110 Irving St NW, Washington, DC, 20010, USA
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45
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Sibert NT, Wesselmann S, Breidenbach C, Blohmer J, Brückner B, Gebauer G, Dos Santos Guilherme M, Hartkopf A, Lindner C, Peschel S, Rieger L, Schad F, Strecker P, Ferencz J, Dieng S, Inwald EC, Kowalski C, Ortmann O. Trastuzumab treatment of patients with early, HER2-positive breast cancer in 17 certified German breast cancer centers. J Cancer Res Clin Oncol 2021; 148:719-726. [PMID: 33914125 DOI: 10.1007/s00432-021-03651-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/22/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Since 2008, guidelines recommend that patients with HER2-positive early breast cancer (BC) should receive adjuvant chemotherapy in combination with trastuzumab in Germany. However, recent studies highlight that a substantial share of patients do not receive trastuzumab. We investigate which patient characteristics are associated with a tumor board recommendation for trastuzumab in Breast Cancer Centers (BCC) certified by the German Cancer Society (DKG) and the German Society for Senology, and if the recommendation differs between BCCs. MATERIALS AND METHODS Multi-level modeling was performed using quality assurance data based on 3052 HER2-positive, operated patients with a first diagnosis of early BC treated between 2006 and 2019 in 17 BCCs in Germany to investigate whether trastuzumab recommendation varies with patient sex, age, and disease characteristics, as well as over time and across BCCs. RESULTS Tumor board recommendations for trastuzumab differ substantially between BCCs (intraclass correlation coefficient [ICC] null model: 0.11). Our final model (ICC 0.17, Akaike Information Criterion [AIC], 1328.0, R2 0.69) shows that physicians in BCCs more often recommend trastuzumab to patients who are younger than 60 years and those with a recommendation for any additional therapy (chemotherapy, radiation or endocrine therapy) (all p < 0.05). Furthermore, there is a significant time-dependent increase of trastuzumab recommendations (odds ratio [OR] = 1.38, 95% confidence interval [CI] = 1.31-1.46, p < 0.05). CONCLUSION In certified BCCs in Germany, guideline concordant trastuzumab recommendation is increasing since 2006 (positive cohort effect). Recommendation of trastuzumab for HER2-positive BC patients in BCCs is significantly associated with patients' age and the recommendations for other additional therapy strategies, apart from surgery. The quality assurance data analyzed do not include potentially relevant confounders, such as socioeconomic status or comorbidities.
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Affiliation(s)
- Nora Tabea Sibert
- German Cancer Society, Kuno-Fischer-Straße 8, 14057, Berlin, Germany.
| | - Simone Wesselmann
- German Cancer Society, Kuno-Fischer-Straße 8, 14057, Berlin, Germany
| | - Clara Breidenbach
- German Cancer Society, Kuno-Fischer-Straße 8, 14057, Berlin, Germany
| | - Jens Blohmer
- Department of Gynaecology Incl. Breast Center (CCM), Charité Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Barbara Brückner
- Krankenhaus Waldfriede, Argentinische Allee 40, 14163, Berlin, Germany
| | - Gerhard Gebauer
- Askplepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Germany
| | | | - Andreas Hartkopf
- Department of Obstetrics and Gynecology, University of Tübingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - Christoph Lindner
- Agaplesion Diakonieklinikum Hamburg, Hohe Weide 17, 20259, Hamburg, Germany
| | - Susanne Peschel
- St. Bernward Krankenhaus, Treiberstraße 9, 31134, Hildesheim, Germany
| | - Lorenz Rieger
- Krankenhaus Landshut-Achdorf, Achdorfer Weg 3, 84036, Landshut, Germany
| | - Friedemann Schad
- Gemeinschaftskrankenhaus Havelhöhe, Kladower Damm 221, 14089, Berlin, Germany
| | - Paul Strecker
- Helios Klinikum Erfurt, Nordhäuser Straße 74, 99089, Erfurt, Germany
| | - Julia Ferencz
- OnkoZert GmbH, Gartenstraße 24, 89231, Neu-Ulm, Germany
| | | | - Elisabeth C Inwald
- Department of Gynaecology, Caritas-Krankenhaus St. Josef, Landshuter Straße 65, 93053, Regensburg, Germany
| | | | - Olaf Ortmann
- Department of Gynaecology, Caritas-Krankenhaus St. Josef, Landshuter Straße 65, 93053, Regensburg, Germany
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Taira N, Sawaki M, Uemura Y, Saito T, Baba S, Kobayashi K, Kawashima H, Tsuneizumi M, Sagawa N, Bando H, Takahashi M, Yamaguchi M, Takashima T, Nakayama T, Kashiwaba M, Mizuno T, Yamamoto Y, Iwata H, Ohashi Y, Mukai H, Kawahara T. Health-Related Quality of Life With Trastuzumab Monotherapy Versus Trastuzumab Plus Standard Chemotherapy as Adjuvant Therapy in Older Patients With HER2-Positive Breast Cancer. J Clin Oncol 2021; 39:2452-2462. [PMID: 33835842 DOI: 10.1200/jco.20.02751] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE We report findings on quality of life (QoL) in the RESPECT trial, which compared adjuvant trastuzumab monotherapy with trastuzumab plus chemotherapy in older patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer (BC). PATIENTS AND METHODS Patients age 70-80 years with human epidermal growth factor receptor 2-positive surgically treated breast cancer were randomly assigned to receive trastuzumab (T) or trastuzumab plus chemotherapy (T + C). QoL was assessed using the Functional Assessment of Cancer Therapy-General (FACT-G), Philadelphia Geriatric Center Morale Scale, Hospital Anxiety and Depression Scale, Patient Neurotoxicity Questionnaire, and Tokyo Metropolitan Institute of Gerontology Index of Competence at baseline and after 2, 12, and 36 months. Comparisons were based on individual changes from baseline and were performed by Fisher's test or mixed-model repeated-measures. RESULTS Among 275 patients in the parent study, 231 (84%) (average age: 74 years) were included in the analysis. At 2, 12, and 36 months, 198, 177, and 178 patients completed surveys, and the mean FACT-G scores at each survey point were 78.9, 80.4, 82.7, and 79.1 in group T and 79.5, 74.5, 78.4, and 78.5 in group T + C. Compared with group T + C, the proportion of patients showing QoL deterioration (≥ 5 points decrease from baseline in FACT-G) was significantly lower at 2 months (31% v 48%; P = .016) and 12 months (19% v 38%; P = .009). In group T, the Hospital Anxiety and Depression Scale score (P = .003) and the proportion of severe sensory peripheral neuropathy (P = .001) were significantly lower at 2 months, and Philadelphia Geriatric Center Morale Scale and Tokyo Metropolitan Institute of Gerontology Index of Competence scores were significantly higher (P = .024, .042) at 12 months. At 36 months, there were no significant differences in any QoL items. CONCLUSION Detrimental effects of adjuvant chemotherapy on global QoL, morale, and activity capacity lasted for at least 12 months but were not observed at 36 months.
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Affiliation(s)
- Naruto Taira
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
| | - Masataka Sawaki
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yukari Uemura
- Biostatistics Section, Department of Data Science, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tsuyoshi Saito
- Department of Surgery, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Shinichi Baba
- Department of Surgery, Sagara Hospital, Kagoshima, Japan
| | - Kokoro Kobayashi
- Department of Medical Oncology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | - Michiko Tsuneizumi
- Department of Breast Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Noriko Sagawa
- Department of Breast Surgery, Kameda Medical Center, Kamogawa, Japan
| | - Hiroko Bando
- Department of Breast and Endocrine Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masato Takahashi
- Department of Breast Surgery, NHO Hokkaido Cancer Center, Sapporo, Japan
| | - Miki Yamaguchi
- Department of Breast Surgery, JCHO Kurume General Hospital, Kurume, Japan
| | - Tsutomu Takashima
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takahiro Nakayama
- Department of Breast and Endocrine Surgery, Osaka International Cancer Institute, Osaka, Japan
| | | | - Toshiro Mizuno
- Department of Medical Oncology, Mie University Hospital, Tsu, Japan
| | - Yutaka Yamamoto
- Department of Breast and Endocrine Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yasuo Ohashi
- Department of Integrated Science and Engineering for Sustainable Society, Chuo University, Tokyo, Japan
| | - Hirofumi Mukai
- Department of Breast and Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takuya Kawahara
- Biostatistics Division, Clinical Research Support Center, The University of Tokyo Hospital, Tokyo, Japan
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Cardiac assessment in Australian patients receiving (neo)adjuvant trastuzumab for HER2-positive early breast cancer: a population-based study. Breast Cancer Res Treat 2021; 187:893-902. [PMID: 33616773 DOI: 10.1007/s10549-021-06135-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/05/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Cardiac function assessment is important for detecting and managing trastuzumab-associated cardiotoxicity. Our study estimates rates and predictors of cardiac assessment among patients receiving trastuzumab for HER2-positive early breast cancer (HER2+EBC) in Australia. METHODS We conducted a retrospective cohort study of Australians initiating (neo)adjuvant trastuzumab for HER2+EBC between 1 January 2015 and 15 April 2019. We used administrative claims to determine the number of patients receiving guideline-recommended assessment, i.e. evidence of baseline cardiac assessment (between 120 days before and 30 days after trastuzumab initiation) and regular on-treatment cardiac assessments (at least every 120 days). We examined factors associated with baseline and regular on-treatment cardiac assessment. RESULTS Our study includes 5621 patients (median age 56 years), of whom 4984 (88.7%) had a baseline cardiac function test. Among 4280 patients with at least 12 months of follow-up, 2702 (63.1%) had guideline-recommended cardiac assessment. Rates of guideline-recommended assessment increased with later year of diagnosis (60.9% in 2015 vs 68.3% in 2018, OR 1.34, 95% CI 1.06-1.69). Patients with higher baseline comorbidities and greater socioeconomic disadvantage were less likely to have guideline-recommended cardiac assessment. Cardiac assessment practices varied by State/Territory. There was no association between baseline cardiac risk or anthracycline use and the likelihood of receiving guideline-recommended cardiac assessment. CONCLUSION The majority of patients receiving (neo)adjuvant trastuzumab had guideline-recommended baseline and on-treatment cardiac assessment. Variations in cardiac assessment predominantly related to system-level factors, such as year of diagnosis and geography, rather than individual patient factors.
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Chen DH, Tyebally S, Malloupas M, Roylance R, Spurrell E, Raja F, Ghosh AK. Cardiovascular Disease Amongst Women Treated for Breast Cancer: Traditional Cytotoxic Chemotherapy, Targeted Therapy, and Radiation Therapy. Curr Cardiol Rep 2021; 23:16. [PMID: 33501515 DOI: 10.1007/s11886-021-01446-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Cardiotoxicity can occur acutely during breast cancer treatment and impact the potential for the intended cancer treatment regime to be completed, or as a late effect affecting cancer survivorship. Indeed, the most common cause of mortality in females with early breast cancer is cardiovascular disease, especially in those over the age of 65. Optimal cancer care therefore needs to be delivered without jeopardising cardiovascular health. Understanding the different cardiotoxicities associated with breast cancer treatment is vital to this approach, and therefore, this article seeks to provide an overview of this. RECENT FINDINGS Tyrosine kinase inhibitors targeting human epidermal growth factor receptor (HER)-2, immune checkpoint inhibitors (ICI), and cyclin-dependent kinase (CDK) inhibitors are new targeted breast cancer treatments. In particular, ICI are associated with myocarditis that carries a significant mortality, whilst the CDK inhibitor ribociclib causes QT prolongation that requires cardiac surveillance and appropriate dose adjustment to prevent ventricular arrhythmias. The need has always been for strategies to mitigate the risks of cardiovascular toxicities, and new data is promising for the use of dexrazoxane in anthracyclines, and the role of beta blockers and angiotensin converting enzymes inhibitors in anthracyclines and HER-2 monoclonal antibodies such as trastuzumab. Significant headways in breast cancer treatment have resulted in reductions in disease recurrence and mortality, but cardiovascular complications continue to impact the ability to deliver some of these cancer treatments, and the period of cancer survivorship.
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Affiliation(s)
- Daniel H Chen
- Cardio-Oncology Service, Bart's Heart Centre, St Bartholomew's Hospital, London, EC1A 7BE, UK.,University College London Hospital, 235 Euston Road, London, NW1 2BU, UK.,The Hatter Cardiovascular Institute, 67 Chenies Mews, London, WC1E 6HX, UK
| | - Sara Tyebally
- Cardio-Oncology Service, Bart's Heart Centre, St Bartholomew's Hospital, London, EC1A 7BE, UK.,University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - Michael Malloupas
- University College London Hospital, 235 Euston Road, London, NW1 2BU, UK.,The Hatter Cardiovascular Institute, 67 Chenies Mews, London, WC1E 6HX, UK
| | - Rebecca Roylance
- University College London Hospital, 235 Euston Road, London, NW1 2BU, UK.,NIHR University College London Hospitals Biomedical Research Centre, Maple House 1st Floor, 149 Tottenham Court Road, London, W1T 7DN, UK
| | - Emma Spurrell
- University College London Hospital, 235 Euston Road, London, NW1 2BU, UK.,Whittington Health, Magdala Avenue, London, N19 5NF, UK
| | - Fharat Raja
- University College London Hospital, 235 Euston Road, London, NW1 2BU, UK.,North Middlesex University Hospital, Sterling Way, London, N18 1QX, UK
| | - Arjun K Ghosh
- Cardio-Oncology Service, Bart's Heart Centre, St Bartholomew's Hospital, London, EC1A 7BE, UK. .,University College London Hospital, 235 Euston Road, London, NW1 2BU, UK. .,The Hatter Cardiovascular Institute, 67 Chenies Mews, London, WC1E 6HX, UK.
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Lyon AR, Dent S, Stanway S, Earl H, Brezden-Masley C, Cohen-Solal A, Tocchetti CG, Moslehi JJ, Groarke JD, Bergler-Klein J, Khoo V, Tan LL, Anker MS, von Haehling S, Maack C, Pudil R, Barac A, Thavendiranathan P, Ky B, Neilan TG, Belenkov Y, Rosen SD, Iakobishvili Z, Sverdlov AL, Hajjar LA, Macedo AV, Manisty C, Ciardiello F, Farmakis D, de Boer RA, Skouri H, Suter TM, Cardinale D, Witteles RM, Fradley MG, Herrmann J, Cornell RF, Wechelaker A, Mauro MJ, Milojkovic D, de Lavallade H, Ruschitzka F, Coats AJ, Seferovic PM, Chioncel O, Thum T, Bauersachs J, Andres MS, Wright DJ, López-Fernández T, Plummer C, Lenihan D. Baseline cardiovascular risk assessment in cancer patients scheduled to receive cardiotoxic cancer therapies: a position statement and new risk assessment tools from the Cardio-Oncology Study Group of the Heart Failure Association of the European Society of Cardiology in collaboration with the International Cardio-Oncology Society. Eur J Heart Fail 2020; 22:1945-1960. [PMID: 32463967 PMCID: PMC8019326 DOI: 10.1002/ejhf.1920] [Citation(s) in RCA: 352] [Impact Index Per Article: 88.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 05/13/2020] [Accepted: 05/25/2020] [Indexed: 12/11/2022] Open
Abstract
This position statement from the Heart Failure Association of the European Society of Cardiology Cardio-Oncology Study Group in collaboration with the International Cardio-Oncology Society presents practical, easy-to-use and evidence-based risk stratification tools for oncologists, haemato-oncologists and cardiologists to use in their clinical practice to risk stratify oncology patients prior to receiving cancer therapies known to cause heart failure or other serious cardiovascular toxicities. Baseline risk stratification proformas are presented for oncology patients prior to receiving the following cancer therapies: anthracycline chemotherapy, HER2-targeted therapies such as trastuzumab, vascular endothelial growth factor inhibitors, second and third generation multi-targeted kinase inhibitors for chronic myeloid leukaemia targeting BCR-ABL, multiple myeloma therapies (proteasome inhibitors and immunomodulatory drugs), RAF and MEK inhibitors or androgen deprivation therapies. Applying these risk stratification proformas will allow clinicians to stratify cancer patients into low, medium, high and very high risk of cardiovascular complications prior to starting treatment, with the aim of improving personalised approaches to minimise the risk of cardiovascular toxicity from cancer therapies.
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Affiliation(s)
- Alexander R. Lyon
- Cardio-Oncology Service, Royal Brompton Hospital and Imperial College, London, UK
- Corresponding author. Cardio-Oncology Service, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK. Tel: +44 20 7352 8121,
| | - Susan Dent
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | | | - Helena Earl
- Department of Oncology, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | | | - Alain Cohen-Solal
- UMR-S 942, Paris University, Cardiology Department, Lariboisiere Hospital, AP-HP, Paris, France
| | - Carlo G. Tocchetti
- Department of Translational Medical Sciences and Interdepartmental Center for Clinical and Translational Research (CIRCET), Federico II University, Naples, Italy
| | - Javid J. Moslehi
- Cardio-Oncology Program, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - John D. Groarke
- Cardio-Oncology Program, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Vincent Khoo
- Department of Clinical Oncology, Royal Marsden Hospital and Institute of Cancer Research, London, UK
- Department of Medical Imaging and Radiation Sciences, Monash University and Department of Medicine, Melbourne University, Melbourne, Australia
| | - Li Ling Tan
- Department of Cardiology, National University Heart Centre, Singapore, National University Health System, Singapore, Singapore
| | - Markus S. Anker
- Division of Cardiology and Metabolism, Department of Cardiology, Charité and Berlin Institute of Health Center for Regenerative Therapies (BCRT) and DZHK (German Centre for Cardiovascular Research), partner site Berlin and Department of Cardiology, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Goettingen Medical Center, Goettingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Goettingen, Goettingen, Germany
| | - Christoph Maack
- Comprehensive Heart Failure Center, University Clinic Würzburg, Würzburg, Germany
| | - Radek Pudil
- First Department of Medicine – Cardioangiology, Charles University Prague, Medical Faculty and University Hospital Hradec Kralove, Prague, Czech Republic
| | - Ana Barac
- MedStar Heart and Vascular Institute, Georgetown University, Washington, DC, USA
| | - Paaladinesh Thavendiranathan
- Ted Rogers Program in Cardiotoxicity Prevention and Joint Division of Medical Imaging, Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Bonnie Ky
- University of Pennsylvania, Philadelphia, PA, USA
| | - Tomas G. Neilan
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Stuart D. Rosen
- Cardio-Oncology Service, Royal Brompton Hospital and Imperial College, London, UK
| | - Zaza Iakobishvili
- Department of Community Cardiology, Tel Aviv Jaffa District, Clalit Health Fund and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aaron L. Sverdlov
- School of Medicine and Public Health, University of Newcastle and “Cancer and the Heart” Program, Hunter New England LHD, Newcastle, Australia
| | - Ludhmila A. Hajjar
- Cardio-Oncology, Department of Cardio-Pneumology, University of São Paulo, São Paulo, Brazil
| | - Ariane V.S. Macedo
- Santa Cardio-Oncology, Santa Casa de São Paulo and Rede Dor São Luiz, São Paulo, Brazil
| | | | - Fortunato Ciardiello
- Department of Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Dimitrios Farmakis
- University of Cyprus Medical School, Nicosia, Cyprus
- Cardio-Oncology Clinic, Heart Failure Unit, “Attikon” University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Rudolf A. de Boer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hadi Skouri
- Cardiology Division, Internal Medicine Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Thomas M. Suter
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Daniela Cardinale
- Cardioncology Unit, European Institute of Oncology, IRCCS, Milan, Italy
| | | | | | - Joerg Herrmann
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Dragana Milojkovic
- Department of Haematology, Hammersmith Hospital, Imperial College, London, UK
| | | | - Frank Ruschitzka
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Andrew J.S. Coats
- University of Warwick, Warwick, UK
- Pharmacology, Centre of Clinical and Experimental Medicine, IRCCS San Raffaele Pisana, Rome, Italy
| | - Petar M. Seferovic
- Faculty of Medicine and Serbian Academy of Sciences and Arts, University of Belgrade, Belgrade, Serbia
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases ‘Prof. C.C. Iliescu’, Bucharest, Romania
- University of Medicine Carol Davila, Bucharest, Romania
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies, Hannover Medical School, Hannover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - M. Sol Andres
- Cardio-Oncology Service, Royal Brompton Hospital and Imperial College, London, UK
| | - David J. Wright
- Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Teresa López-Fernández
- Cardiology Service, Cardio-Oncology Unit, La Paz University Hospital and IdiPAz Research Institute, Ciber CV, Madrid, Spain
| | - Chris Plummer
- Department of Cardiology, The Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle, UK
| | - Daniel Lenihan
- Cardio-Oncology Center of Excellence, Washington University in St Louis, St Louis, MO, USA
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Liuu E, Saulnier PJ, Gand E, Ragot S, Valero S, Jamet A, Hadjadj S, Paccalin M. Frailty and diabetes status in older patients with cancer: impact on mortality in the ANCRAGE cohort. Aging Clin Exp Res 2020; 32:1809-1819. [PMID: 31898171 DOI: 10.1007/s40520-019-01362-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 09/21/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Frailty, diabetes and cancer are associated with aging, but the relationship between these conditions is not well defined. AIMS We studied older patients with cancer from the prospective single-center cohort ANCRAGE (ANalyses of CanceR in AGEd) aiming to determine the impact of type 2 diabetes (T2D) and its vascular complications (VC) on frailty and adverse outcomes (mortality, unplanned readmission) during follow-up. METHODS Analysis of cohort patients ≥ 75 years, included between 2009 and 2017, who underwent a comprehensive geriatric assessment (CGA). Variables of interest were history of T2D and VC, tumor site and metastatic status, CGA including eight domains (social environment, functional status, mobility, nutrition, mood, cognition, polypharmacy and comorbidities) and frailty. RESULTS Among 1092 patients (47% female, mean age 82 ± 5 years), 219 (20%) had a reported diagnosis of T2D at baseline including 152 (69%) with VC. The most common tumor sites were prostate (15%), breast (15%), skin (12%), and colorectum (11%); 29% of patients had a metastatic disease. Frailty was highly prevalent (84%). During follow-up (median of 15.3 months), 653 (60%) patients died (60% no T2D, 43% T2D without VC, 66% with VC). After adjustment for age, gender and metastatic status, diabetics with VC had a higher risk of all-cause death (aHR1.89, 1.24-2.86, p = 0.004). Death was more frequently due to a non-cancer cause (p < 0.001). No difference in unplanned readmissions was observed in the three groups. Frailty was an independent risk factor for mortality and unplanned readmissions (p < 0.001 both). CONCLUSION In older cancer patients from the prospective ANCRAGE cohort, all-cause mortality was significantly higher in frail patients and those with complicated T2D, a finding questioning the quality of care management in such vulnerable patients, and stimulating further research in this multidisciplinary field.
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