Cardiovascular risk profile of patients with HER2/neu-positive breast cancer treated with anthracycline-taxane-containing adjuvant chemotherapy and/or trastuzumab.
OBJECTIVE
To evaluate the cardiovascular risk profile of a subset of patients with early-stage breast cancer treated with adjuvant taxane-anthracycline-containing chemotherapy and/or trastuzumab (Herceptin).


METHODS
Twenty-six patients with breast cancer (mean, 20 months postchemotherapy) and 10 healthy age-matched women were studied. We measured 14 metabolic and vascular established cardiovascular disease (CVD) risk factors, body mass index, cardiorespiratory fitness, and left ventricular systolic function. All assessments were done within a 14-day period.


RESULTS
Cardiac abnormalities were suggested by left ventricular ejection fraction (LVEF) <50% in 8% of patients, LVEF remained >10% below pretreatment values in 38%, whereas 50% presented with resting sinus tachycardia. Brain natriuretic peptide was significantly elevated in 40% of patients and was correlated with LVEF (r = -0.72, P =or< 0.001). For the majority of CVD risk factors, similar proportions of patients and controls (35-60%) were classified as "undesirable." A significantly higher proportion of patients were classified with low cardiorespiratory fitness (46% versus 0%, P < 0.01), being overweight/obese (72% versus 50%, P < 0.05), and having resting sinus tachycardia (50% versus 0%, P < 0.01) compared with controls. Cardiorespiratory fitness and body mass index were correlated with CVD risk factors (r = -0.64 to 0.63, P < 0.05; r = -0.63 to 0.67, P < 0.05, respectively). Exploratory analyses revealed several differences between CVD risk factors based on chemotherapy regimen.


CONCLUSIONS
Breast cancer survivors treated with adjuvant chemotherapy are at a higher risk of developing late-occurring CVD than age-matched controls due to direct and indirect treatment-related toxicity.
Jones
Lee W
LW
Department of Surgery, Duke University Medical Center, Box 3624, Durham, NC 27710, USA. lee.w.jones@duke.edu
Haykowsky
Mark
M
Peddle
Carolyn J
CJ
Joy
Anil A
AA
Pituskin
Edith N
EN
Tkachuk
Linda M
LM
Courneya
Kerry S
KS
Slamon
Dennis J
DJ
Mackey
John R
JR
D000328:Adult; D018943:Anthracyclines / Q000009:adverse effects* / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000145:classification / Q000188:drug therapy*; D001952:Bridged-Ring Compounds / Q000009:adverse effects* / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000139:chemically induced*; D016022:Case-Control Studies; D017024:Chemotherapy, Adjuvant; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D010101:Oxygen Consumption / Q000187:drug effects; D010865:Pilot Projects; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000276:immunology / Q000378:metabolism; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume / Q000187:drug effects; D013616:Tachycardia, Sinus / Q000139:chemically induced; D043823:Taxoids / Q000009:adverse effects* / Q000627:therapeutic use; D000068878:Trastuzumab
D018943:Anthracyclines; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D001952:Bridged-Ring Compounds; D018719:Erb-b2 Receptor Tyrosine Kinases; D043823:Taxoids; D000068878:Trastuzumab; C080625:taxane