Pharmacy - Clinical Pharmacy

Background: Anthracycline-based chemotherapy has played a significant role in the
treatment of various breast cancer stages with reduced rates of both relapse and mortality.
However their benefits have been limited due to their adverse events ranging from
myelosuppression to well-established risk of cardiotoxicity.
Aim: Investigate the correlation between incidence of cardiotoxicity and risk factors in breast
cancer patients treated with Anthracyclines and outline current strategies for prevention of
Anthracycline induced cardiotoxicity.
Subjects and Method: 60 breast cancer patients, (stages II&IIIA), with age ranging from 30
to 65 years, newly diagnosed and scheduled for chemotherapy .Our study population were
classified into group 1 (30 patients receiving Anthracycline-based chemotherapy) and group 2(
30 patients receiving Trastuzumab combined with anthracycline-based chemotherapy).
Parameters to be measured: ejection fraction, blood pressure, body mass index, and baseline
heart rate to record any case of Heart Failure (HF) following anthracyclines treatment.
Results: The main comorbidities related to cardiotoxicity among study population were
hypertension (44%), diabetes (31%), obesity (90%), and age above 55 years (48%). Baseline
ejection fraction recorded for all patients ranges from (42% to 76%). (26 patients) had already
diastolic dysfunction grade 1, but only (4 patients) had a substandard ejection fraction. (13
patients) had changes in chemotherapy regimen based on ejection fraction. Group (1) was
associated with a HF incidence rate (6.7%) compared to group (2) having significantly increased
HF incidence rate (20%).
Conclusions: Group (2) had a significant increased incidence of cardiotoxicity. Our
study,among previous studies, shed a light about routine echocardiography prior to anthracycline
therapy and might eventually lead to current practice guidelines modifications.
Keywords: Anthracycline, cardiotoxicity, incidence, Trastuzumab, Echocardiography,
prevention.