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Prediction of trastuzumab-induced cardiotoxicity in breast cancer patients receiving anthracycline-based chemotherapy

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A Letter to the Editor to this article was published on 07 February 2019

Abstract

Background

Adjuvant trastuzumab improved overall survival and reduced the risk for disease recurrence in women with breast cancers, because of its potential cardiotoxicity, careful monitoring of left ventricular (LV) function during treatment is required.

Methods

This study investigates, whether myocardial strain imaging and level of N-terminal pro-brain natriuretic peptide (NT-pro BNP) could predict subsequent reduction in LVEF in breast cancer patients received adjuvant trastuzumab. 61 women with pathologically proven breast cancer HER-2 positive received AC (Doxorubicin–Cyclophosphamide) for 4 cycles, followed by paclitaxel with Trastuzumab were enrolled. Clinical, conventional echocardiographic parameters, myocardial strain imaging [global longitudinal peak systolic strain (GLS), radial and circumferential systolic strain] and level of NT pro-BNP were measured at baseline, after 3, 6, 9 and 12 months of trastuzumab therapy.

Results

Of 61 patients, 18 patients (29.5%) developed trastuzumab-induced cardiomyopathy (CM) at 6 and 9 months of therapy (LVEF declines ≥ 10%), GLS and radial strain significantly decreased in CM group at 3 months of trastuzumab treatment, the value of GLS at 3 months was the strongest predictors of cardiotoxicity its area under the curve (AUC 0.98) with an optimal cut-off for GLS (− 18%) having 92.5% sensitivity and 83% specificity. NT-pro BNP levels were not predictive of later trastuzumab-induced cardiac dysfunction.

Conclusion

Myocardial strain imaging has been able to predict pre-clinical changes in LV systolic function and GLS is an independent early predictor of subsequent reduction in EF in breast cancer patients treated with trastuzumab.

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Funding

This study was not funded.

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Authors and Affiliations

  1. Cardiovascular Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt

    Wafaa S. El-Sherbeny

  2. Clinical Oncology Department, Faculty of Medicine, Tanta University, Tanta, Egypt

    Nesreen M. Sabry

  3. Clinical Pathology Department, Faculty of Medicine, Tanta University, Tanta, Egypt

    Radwa M. Sharbay

Authors
  1. Wafaa S. El-Sherbeny
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  2. Nesreen M. Sabry
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  3. Radwa M. Sharbay
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Corresponding author

Correspondence to Wafaa S. El-Sherbeny.

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Conflict of interest

Wafaa S. El-Sherbeny, Nesreen M. Sabry and Radwa M. Sharbay declare that they have no conflict of interest.

Ethical approval

This study was approved by the Ethics Committee in the Faculty of Medicine, Tanta University and with Helsinki Declaration of 1964 and later revision.

Informed consent

Informed consent was obtained from all patients included in the study.

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El-Sherbeny, W.S., Sabry, N.M. & Sharbay, R.M. Prediction of trastuzumab-induced cardiotoxicity in breast cancer patients receiving anthracycline-based chemotherapy. J Echocardiogr 17, 76–83 (2019). https://doi.org/10.1007/s12574-018-0394-4

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  • DOI: https://doi.org/10.1007/s12574-018-0394-4

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