Ispitivanje kardiotoksičnog efekta anti-HER2 terapije kod pacijenata sa karcinomom dojke
Introduction: Anti-HER2 therapy nowadays represents the standardtherapeutic approach in the treatment of HER2 positive breast cancer.Notwithstanding its beneficial, therapeutic effects in breast cancer treatment,the most important side effect of the therapy is its cardiotoxicity, manifestedas asymptomatic reduction of left ventricular ejection fraction, but it rarelyproduces evident heart failure.The aim of this study was to investigate cardiotoxic effects of anti-HER2therapy (trastuzumab and lapatinib) in HER2 positive breast cancer patients.Method: In the period from December 2018 to February 2022, we evaluated106 female patients with HER2 positive breast cancer, receiving anti-HER2therapy with trastuzumab (96 patients); and lapatinib (10 patients) aftertrastuzumab treatment for metastatic disease. Cardiotoxic effect of the therapywas assessed based on anamnestic information, clinical examination, bloodpressure and heart rate measurement, electrocardiography andechocardiography. Average values of blood pressure, heart rate,echocardiographic parameters (ejection fraction – EF; fractional shortening –FS; end-diastolic diameter – EDD; left ventricular mass – LVM) werecompared at the beginning and after the therapy with trastuzumab andlapatinib. The impact of risk factors for cardiotoxicity (age, previous radiationand anthracycline therapy, cardiovascular risk factors) and the effect of betablockers,ACE inhibitors, Ca-antagonists, diuretics and statins on EF, FS,EDD and LVM were investigated. Blood pressure measurement wasperformed with sphygmomanometers, after Riva-Rocci. Standard 12-leadelectrocardiography was employed. Standard two-dimensionalechocardiography was done on an ACUSON SC2000 ultrasound system.Ejection fraction (EF%) was determined using the Simpson's biplane method.Results: In 96 studied patients, with the average age of 59.57 years, EFreduction after trastuzumab therapy was 1.73% (p=0.007); in 4.16%asymptomatic cardiotoxicity developed according to the EACVI and ASEcriteria. Patients over 65 years of age (4.56%; p=0.002); those with VIanthracycline cycles (1.77%; p=0.048); with prior radiation therapy (6.58 %;p=0.005); and those with left breast radiation therapy (6.14%; p=0.02) had asignificant EF reduction after trastuzumab therapy. Patients with risk factorsAbstract:had EF reduction by 2.58% (p=0.001), with the greatest reduction observed inthe obese (EF=4.02; p=0.009). Increased EDD was found in patients over 65years of age (1.07 mm, p=0.037); those with prior radiation therapy (1.30mm; p=0.13), particularly with the irradiated left breast (1.72 mm; p=0.032);and in those with risk factors (1.09 mm; p=0.031). LVM increased by 3.61 g(p=0.031) after trastuzumab therapy. The LVM increase occurred in thosewith hyperlipidemia as a risk factor (14.57 g; p=0.050) and in those whoreceived beta-blockers (16 g; p=0.012).Conclusion: Treatment with trastuzumab has an impact on the reduction ofleft ventricular ejection fraction, increase of end-diastolic diameter and leftventricular mass. The observed cardiotoxicity rate was nevertheless low, andcardiotoxicity was reversible.
Biografija autora: list 86,Bibliografija: list. 74-85. Datum odbrane: 22.11.2022. Оncology
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