br d ejection ventriculaire gauche FEVG finale L
d’ejection ventriculaire gauche (FEVG) finale. L’analyse de la cova-
riance (ANCOVA) a ete utilisee pour evaluer la relation entre l’ex-position à la statine et la FEVG finale. Un modèle de regression
logistique a ete elabore pour evaluer la relation entre l’exposition à la
statine et la cardiotoxicite (critère d’evaluation secondaire).
Anthracyclines and trastuzumab are 2 effective drugs that are used to treat women with human epidermal growth factor receptor 2-positive (HER2þ) breast cancer. However, these drugs are associated with a risk of cancer treatment-related
Corresponding author: Dr Paaladinesh Thavendiranathan, Peter Munk Cardiac Center, Ted Rogers Program in Cardiotoxicity Prevention, Toronto General Hospital, University of Toronto, 4N-490, 585 University Ave, Toronto, Ontario M5G 2N2, Canada. Tel.: þ1-416-340-5326; fax: þ1-416-340-3640. E-mail: [email protected] See page 158 for disclosure information.
cardiac dysfunction (CTRCD).1,2 Strategies to mitigate CTRCD have included primary prevention with car-dioprotective medications or cardiac surveillance to detect subclinical cardiac injury followed by intervention. For primary prevention, renin-angiotensin system inhibitors and b-blockers are the most common therapies studied.3 How-ever, these drugs can reduce 130466-38-5 rate and blood pressure and contribute to fatigue. As a consequence, they are often poorly tolerated in patients receiving cancer therapy who are already fatigued from the cancer, its treatment, or anemia and are intravascularly volume depleted because of poor oral intake, vomiting, and diarrhea. This prompted clinicians to consider alternate cardioprotective medications. Statins are
Conclusions: In women with HER2þ breast cancer receiving trastuzumab-based therapy with or without anthracyclines, concomi-tant use of statins was associated with a lower risk of cardiotoxicity.
Canadian Journal of Cardiology Volume 35 2019
Resultats : L’etude portait sur 129 patientes (62 9 ans). Quarante-trois patientes ont reçu des statines durant le traitement de leur
cancer. La duree mediane d’exposition au trastuzumab etait de 11,8
(ecart interquartile [EIQ] de 11 à 12) mois. Soixante-douze (56 %) patientes avaient reçu des anthracyclines. Comparativement aux
traitement par la statine etait associe de façon independante à un risque de cardiotoxicite plus faible (rapport des cotes [RC] 0,32, intervalle de confiance [IC] à 95 %, 0,10-0,99, p ¼ 0,049). Conclusions : Chez les femmes atteintes de cancer du sein HER2þ ayant reçu un traitement à base de trastuzumab avec ou sans anthracyclines, la prise concomitante d’une statine etait associee à un risque de cardiotoxicite plus faible.
hypothesized to have pleiotropic effects, including anticancer, antioxidative, and anti-inflammatory effects.4,5 In fact, animal models and small clinical studies have shown that statins could provide cardioprotection during anthracycline treatment.6-9 Whether statins also confer cardioprotective effects in trastuzumab-treated patients has not yet been studied.
Our objective was to assess whether statin exposure during trastuzumab treatment (with or without anthracyclines) in women with HER2þ breast cancer is associated with cardioprotective effect. We hypothesized that trastuzumab-treated patients who were exposed to statins during their treatment would have a lower decline in left ventricular ejection fraction (LVEF) and lower incidence of cardiotoxicity compared with those who were not exposed to statins.
Material and Methods
This is a retrospective case-control study based on elec-tronic chart review of consecutive women with HER2þ breast cancer treated with trastuzumab-based therapy at Princess Margaret Cancer Center (Toronto, ON) between 2002 and 2013. Patients were included if they received a pretherapy multigated acquisition (MUGA) scan and 2 subsequent follow-up scans during the course of their treatment. We identified patients who were receiving any statin (regardless of clinical indication) before and during cancer treatment. Each statin-treated patient was randomly matched with 2 patients of the same age ( 2 years) and anthracycline exposure status but without statin treatment before or during cancer treat-ment. The LVEF data were not available at the time of matching. The study complies with the Declaration of Helsinki; it was approved by the University Health Network (UHN) Research Ethics Board; and, given its retrospective nature, the Research Ethics Board waived the need for informed consent.