Association of body mass index and cardiotoxicity related to anthracyclines and trastuzumab in early breast cancer: French CANTO cohort study

English version

Autoři: Elisé G. Kaboré ^aff001; Charles Guenancia ^aff002; Ines Vaz-Luis ^aff003; Antonio Di Meglio ^aff003; Barbara Pistilli ^aff003; Charles Coutant ^aff004; Paul Cottu ^aff005; Anne Lesur ^aff006; Thierry Petit ^aff007; Florence Dalenc ^aff008; Philippe Rouanet ^aff009; Antoine Arnaud ^aff010; Olivier Arsene ^aff011; Mahmoud Ibrahim ^aff012; Johanna Wassermann ^aff013; Geneviève Boileau-Jolimoy ^aff014; Anne-Laure Martin ^aff015; Jérôme Lemonnier ^aff015; Fabrice André ^aff003; Patrick Arveux ^aff001
Působiště autorů: “Health across Generations” Team, Inserm U1018, Centre for Research in Epidemiology and Population Health (CESP), Villejuif, France ^aff001; Cardiology Department, University Hospital Dijon Bourgogne, Dijon, France ^aff002; Institut Gustave Roussy, Villejuif, France ^aff003; Centre Georges-François Leclerc, Dijon, France ^aff004; Institut Curie, Paris, France ^aff005; Centre Alexis Vautrin, Vandoeuvre les Nancy, France ^aff006; Centre Paul Strauss, Strasbourg, France ^aff007; Institut Claudius Regaud, Toulouse, France ^aff008; Institut du Cancer de Montpellier, Montpellier, France ^aff009; Clinique Sainte Catherine, Avignon, France ^aff010; Centre Hospitalier de Blois, Blois, France ^aff011; Centre Hospitalier Régional d’Orléans, Orléans, France ^aff012; AP-HP Pitié-Salpêtrière, Paris, France ^aff013; Polyclinique du Parc Drevon, Dijon, France ^aff014; Unicancer, Paris, France ^aff015
Vyšlo v časopise: Association of body mass index and cardiotoxicity related to anthracyclines and trastuzumab in early breast cancer: French CANTO cohort study. PLoS Med 16(12): e1002989. doi:10.1371/journal.pmed.1002989
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pmed.1002989

Souhrn

Background

In patients treated with cardiotoxic chemotherapies, the presence of cardiovascular risk factors and previous cardiac disease have been strongly correlated to the onset of cardiotoxicity. The influence of overweight and obesity as risk factors in the development of treatment-related cardiotoxicity in breast cancer (BC) was recently suggested. However, due to meta-analysis design, it was not possible to take into account associated cardiac risk factors or other classic risk factors for anthracycline (antineoplastic antibiotic) and trastuzumab (monoclonal antibody) cardiotoxicity.

Methods and findings

Using prospective data collected from 2012–2014 in the French national multicenter prospective CANTO (CANcer TOxicities) study of 26 French cancer centers, we aimed to examine the association of body mass index (BMI) and cardiotoxicity (defined as a reduction in left ventricular ejection fraction [LVEF] > 10 percentage points from baseline to LVEF < 50%). In total, 929 patients with stage I–III BC (mean age 52 ± 11 years, mean BMI 25.6 ± 5.1 kg/m², 42% with 1 or more cardiovascular risk factors) treated with anthracycline (86% epirubicin, 7% doxorubicin) and/or trastuzumab (36%), with LVEF measurement at baseline and at least 1 assessment post-chemotherapy were eligible in this interim analysis. We analyzed associations between BMI and cardiotoxicity using multivariate logistic regression. At baseline, nearly 50% of the study population was overweight or obese. During a mean follow-up of 22 ± 2 months following treatment completion, cardiotoxicity occurred in 29 patients (3.2%). The obese group was more prone to cardiotoxicity than the normal-weight group (9/171 versus 8/466; p = 0.01). In multivariate analysis, obesity (odds ratio [OR] 3.02; 95% CI 1.10–8.25; p = 0.03) and administration of trastuzumab (OR 12.12; 95% CI 3.6–40.4; p < 0.001) were independently associated with cardiotoxicity. Selection bias and relatively short follow-up are potential limitations of this national multicenter observational cohort.

Conclusions

In BC patients, obesity appears to be associated with an important increase in risk-related cardiotoxicity (CANTO, ClinicalTrials.gov registry ID: NCT01993498).

Trial registration

ClinicalTrials.gov NCT01993498.

Klíčová slova:

Body Mass Index – Breast cancer – Cancer chemotherapy – Cancer risk factors – Cancer treatment – Hypertension – Obesity

Zdroje

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