EONS 2024: Risk Stratification for Cardiotoxicity in Breast Cancer Patients Treated with Anthracycline/Trastuzumab

In this video, Prof Lise-Marie Kinnaer discusses and comments on the data from a study she presented during the annual meeting of the European Oncology Nursing Society.(EONS 2024) 

This study focused on the importance of risk stratification for cardiotoxicity in breast cancer patients treated with anthracyclines or trastuzumab. These therapies are known to induce cardiotoxicity, with anthracyclines carrying a risk of up to 50% when combined with other cardiotoxic treatments and trastuzumab presenting a risk of 18.6%, particularly in reducing left ventricular ejection fraction. Current guidelines recommend performing risk stratification—classifying patients into low, moderate, high, or very high risk—before initiating treatment, with tailored cardiac follow-up and potential referral to a cardiologist based on the risk category. Despite these recommendations, risk stratification is not systematically implemented in clinical practice in Belgium. A retrospective analysis was conducted in two Belgian hospitals to investigate the value of systematic risk assessment. Data were collected from 77 patient records of those treated with anthracyclines and trastuzumab, and follow-up was performed for the first six months of treatment. Baseline risk factors (e.g., age, cardiovascular history, lifestyle, and biological parameters) were evaluated alongside occurrences of cardiotoxicity and treatment interventions such as interruptions or the initiation of cardioprotective therapies. The analysis showed that 50% of patients were at low risk, while the other 50% fell into moderate to high-risk categories, with approximately 16% at high risk. Notably, 80% of patients had at least one risk factor, with smoking, arterial hypertension, and obesity present in over 25% of cases. Although cardiotoxic manifestations were relatively low in the first six months, this was expected as these effects often emerge after one year. Approximately 10% of patients experienced treatment interventions.

The study highlights the importance of systematic risk stratification in breast cancer patients receiving these cardiotoxic treatments. Identifying patients at moderate to high risk allows for the initiation of preventive strategies, such as lifestyle modifications, to reduce the likelihood of cardiotoxicity developing during cancer treatment. This small sample analysis underscores the need for broader implementation of risk assessment in clinical practice to optimise patient outcomes.