Cardiotoxicités liées au traitement par anthracyclines et/ou anti-HER 2 des cancers du sein : résultats de la prise en charge standardisée dans un centre de cardio-oncologie

Abstract : Background: The increase in the number of cancer survivors in recent years has led to the progression of cardiovascular complications related to exposure to anti-cancer treatments. The early detection of these cardiotoxicities, particularly left ventricular systolic dysfunction, which is a source of significant morbidity and mortality, appears to be a challenge. As the LVEF decline is too late, it is currently recommended to follow troponin and Global Longitudinal Strain. But, the application of these recent recommendations, most of which have a low level of evidence, has not been studied in everyday practice. The objective of this study was to evaluate the incidence of cardiotoxicity, as defined by the recommendations, in patients treated for breast cancer with Anthracycline and / or anti HER2, and to determine the predictive factors. Methods: This is a retrospective, single-center study that included all major patients, treated with Anthracyclines and / or anti HER2 in the context of breast cancer in the Medi-CO Center in Marseille. Cardiotoxicity was defined as elevation of troponin or decreased of GLS or LVEF as defined in the recommendations. The data were collected from the standardized forms completed at the end of each consultation or from the computerized patient record for troponin, taken after each treatment. Results: Between July 2015 and December 2017, 104 patients were followed in the Medi-CO Center. Forty-seven patients were excluded and 57 were finally included in the study. Seventeen patients (30%) had cardiotoxicity with a median onset of 177 days (90-284). One was a decrease in LVEF (2%), 9 (53%) isolated GLS impairment, 4 (7%) isolated troponin elevation, and 3 (5%) GLS decline associated with an elevation of troponin. The only factor statistically associated with the occurrence of cardiotoxicity was low BMI (OR 0.83, 95% CI 0.70-0.94, p = 0.005). Conclusion: The signs suggestive of cardiotoxicity were identified early in 30% of patients treated with Anthracyclines and/or Trastuzumab for breast cancer. Nevertheless, it was never serious forms. Despite low numbers and short follow-up time, we identified low BMI as a predictor of cardiotoxicity. None of the patients who had experienced troponin elevation and / or GLS decreased to impaired LVEF. These first results, very encouraging, fully justify the growth of cardio-oncology. Other real-life studies will need to be conducted to develop knowledge in this area to standardize practices around higher-level recommendations. These efforts will further improve the quality of life and survival of patients treated for cancer.
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Marion Escudier. Cardiotoxicités liées au traitement par anthracyclines et/ou anti-HER 2 des cancers du sein : résultats de la prise en charge standardisée dans un centre de cardio-oncologie. Sciences du Vivant [q-bio]. 2018. ⟨dumas-01940238⟩

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