Clinical & Experimental Cardiology
Open Access
ISSN: 2155-9880
+44 1300 500008
ISSN: 2155-9880
+44 1300 500008
Afrah Aladwani, Alexander Mullen, Mohammad Alrashidi, Omamah Alfarisi, Faisal Alterkait, Abdulwahab Aladwani, Asit Kumar, Marie Boyd, Emad Eldosouky
University of Strathclyde, UK. Kuwait Oil Company, Kuwait. Kuwait University, Kuwait. Kuwait Cancer Control Centre, Kuwait. Public Authority for Sport Kuwait.
Posters & Accepted Abstracts: J Clin Exp Cardiolog
Introduction: Trastuzumab is an HER-2 targeted humanized monoclonal antibody that significantly improves breast cancer therapeutic outcomes. However, it is associated with an increased cardiotoxicity risk that ranges from a mild decline in the cardiac ejection fraction to permanent cardiomyopathy. Concerns have been raised in treating eligible older patients. This study compares trastuzumab outcomes between two age cohorts in the Kuwait Cancer Control Centre (KCCC). Methods: In a prospective comparative observational study, 93 HER-2 positive breast cancer patients undergoing different chemotherapy protocols + trastuzumab were included and divided into two cohorts based on their age (�?60 and ≥60 years old). The baseline left ventricular ejection fraction (LVEF) was assessed and monitored every three months. The event of cardiotoxicity was defined as ≥10% decline in the LVEF from the baseline value. The lower accepted LVEF level was 50%. The individual decline in the LVEF from the baseline was calculated and compared between the two age cohorts. Logistic regression analysis was applied to investigate the association between age, comorbidities, BMI, anthracycline treatment, and baseline LVEF value, and trastuzumab-induced cardiotoxicity after adjusting for the disease stage. Results: The median baseline LVEF was 65% in both age cohorts (IQR 8% and 9% for older and younger patients, respectively). Whereas the median LVEF post-trastuzumab treatment was 51% and 55% in older and younger patients, respectively (IQR 8%; p-value = 0.22), even though older patients had significantly lower exposure to anthracyclines compared to younger patients (60% and 84.1%, respectively; p-value �?0.001). 86.7% of older and 55.6% of younger patients developed ≥10% decline in their LVEF from the baseline. Among those, only 29% of older and 27% of younger patients reached LVEF value below 50%. On regression analysis, age was the only factor correlated with developing ≥10% decline in LVEF (OR 4; p-value �?0.012), but it did not increase the requirement for permanent trastuzumab discontinuation. Besides, a baseline LVEF value below 60% contributed to reaching LVEF value below normal ranges (�?�50%). Conclusion: Breast cancer patients aged 60 years and above in Kuwait were at a 4-fold higher risk of developing ≥10% decline in their LVEF from the baseline value compared to younger patients during trastuzumab treatment. Previous exposure to anthracyclines and comorbidities were not independent factors contributing to increased cardiotoxicity risk in this study.