Center for Epidemiology and Healthcare Delivery Research, JPS Health Network, 1500 South Main Street, Fort Worth, TX, 76104, USA.
Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
Breast Cancer Res Treat. 2022 Oct;195(3):401-411. doi: 10.1007/s10549-022-06695-0. Epub 2022 Aug 15.
Evidence of cardiotoxicity risk related to anthracycline or trastuzumab exposure is largely derived from breast cancer cohorts that under-represent socioeconomically marginalized women, who may be at increased risk of cardiotoxicity because of high prevalence of cardiovascular disease risk factors. Therefore, we aimed to estimate cardiotoxicity risk among socioeconomically marginalized breast cancer patients treated with anthracyclines or trastuzumab and describe clinical consequences of cardiotoxicity.
We linked electronic health records with institutional registry data from a Comprehensive Community Cancer Program within a safety-net health system. Eligible patients were adult females, diagnosed with first primary invasive breast cancer between 2013 and 2017, and initiated anthracyclines or trastuzumab as part of first-line therapy. We estimated cumulative incidence (risk) of cardiotoxicity with corresponding 95% confidence limits (CL) using the Aalen-Johansen estimator with death as competing risk.
Our study population comprised 169 women with breast cancer (103 initiated anthracyclines and 66 initiated trastuzumab). Cumulative incidence of cardiotoxicity was 21% (95% CL: 12%, 32%) at one year and 25% (95% CL: 15%, 35%) at three years among women who initiated trastuzumab, whereas cumulative incidence was 3.9% (95% CL: 1.3%, 8.9%) at one year and 5.9% (95% CL: 2.4%, 12%) at three years among women who initiated anthracyclines. More than half of patients with cardiotoxicity experienced interruption of cancer treatment.
Our findings suggest high risk of cardiotoxicity among socioeconomically marginalized breast cancer patients after initiation of anthracyclines or trastuzumab. Strategies are needed for optimizing cancer treatment effectiveness while minimizing cardiotoxicity in this population.
与蒽环类药物或曲妥珠单抗暴露相关的心脏毒性风险的证据主要来自乳腺癌队列，这些队列代表性不足，未能涵盖社会经济地位边缘化的女性，而这些女性由于心血管疾病风险因素的高发，可能面临更高的心脏毒性风险。因此，我们旨在评估接受蒽环类药物或曲妥珠单抗治疗的社会经济地位边缘化乳腺癌患者的心脏毒性风险，并描述心脏毒性的临床后果。
我们将电子健康记录与安全网卫生系统内的综合社区癌症计划的机构注册数据进行了链接。合格的患者为成年女性，在 2013 年至 2017 年间被诊断为首次原发性浸润性乳腺癌，并接受了蒽环类药物或曲妥珠单抗作为一线治疗的起始治疗。我们使用 Aalen-Johansen 估计量（以死亡为竞争风险）估计心脏毒性的累积发生率（风险），并给出相应的 95%置信区间（CL）。
我们的研究人群包括 169 名患有乳腺癌的女性（103 名接受蒽环类药物治疗，66 名接受曲妥珠单抗治疗）。接受曲妥珠单抗治疗的女性，一年时心脏毒性的累积发生率为 21%（95%CL：12%，32%），三年时为 25%（95%CL：15%，35%）；而接受蒽环类药物治疗的女性，一年时的累积发生率为 3.9%（95%CL：1.3%，8.9%），三年时为 5.9%（95%CL：2.4%，12%）。超过一半的心脏毒性患者中断了癌症治疗。
我们的研究结果表明，在接受蒽环类药物或曲妥珠单抗治疗后，社会经济地位边缘化的乳腺癌患者心脏毒性风险较高。需要制定策略，在优化癌症治疗效果的同时，最大限度地降低该人群的心脏毒性风险。
