BACKGROUND

Early signs of cardiotoxicity, such as increased cardiac troponins and reduced global longitudinal strain (GLS), may guide the initiation of cardioprotective therapy (CPT) to prevent cancer therapy-related cardiac dysfunction (CTRCD).

OBJECTIVE

To compare the effectiveness of risk-guided cardiac management (RGM) of HER2-positive breast cancer (BC) patients receiving potentially cardiotoxic therapy with usual care (UC).

MATERIAL AND METHODS

We randomized 120 patients with HER2-positive BC (age 48.5 [41.0; 58.0] years) scheduled to receive anthracycline and trastuzumab-based cancer therapy into RGM group (initiation /correction of CPT in case of high-sensitivity troponin I>reference value and/or >15% relative reduction in GLS) (n=80) and UC group (n=40). Clinical examination and echocardiography were performed at baseline and after therapy. The primary end point was left ventricular ejection fraction (LV EF) change (Δ EF).

RESULTS

The follow–up was completed in 72 and 32 patients in both groups, respectively. The share of patients receiving cardioprotective therapy increased by 51.4% and 21.9%, respectively (p=0.005). LV EF decreased in both groups. Δ LVEF was –5.2 [–9.0; –2.0] % and –8 [–10.1; –4.9] % (p=0.032), Δ GLS — –2.3 [–3.9; –0.6] % and –4.2 [–5.0; –2.8] % (p=0.003), respectively. In the RGM group, LV EF and GLS after therapy were higher (57.5 [54.5; 60.0] % versus 55.0 [54.0; 56.5] % (p=0.027), –18.8 [–17.2; –20.2]% versus –17.8 [–16.2; –18.5]%, p=0.042, respectively). LV dysfunction caused therapy interruption in 1 (1.4%) and 3 (9.4%) patients, respectively (p=0.085).

CONCLUSION

RGM of patients with HER2-positive breast cancer is associated with less severe deterioration of LV systolic function compared to conventional clinical practice.