కార్డియోవాస్కులర్ డిసీజెస్ & డయాగ్నోసిస్

Cardiotoxicity of First-Line Chemotherapy in Patients with Advanced Non-Small Cell Lung Cancer

Abstract

Daliborka B

Background: The main goal of chemotherapy is to destroy tumor cells at the maximum with minimal damage to healthy tissue, which is sometimes difficult to achieve due to the non-selectivity of chemotherapeutics. Cardiotoxicity become important in the past several years, as significant progress has been made in both, early diagnosis and the use of increasingly advanced antitumor drugs. The aim of this study was to establish the frequency of cardiotoxicity in the patients treated with the first-line chemotherapy (gemcitabine and cisplatin vs paclitaxel and carboplatin).

Methods: This prospective study included 240 non-small cell lung cancer patients at the clinical stages III and IV. Patients are divided into groups according to the type of chemotherapy (gemcitabine and cisplatin versus paclitaxel and carboplatin) and cardiovascular co-morbidities. Physical examination, electrocardiogram and NTproBNP (Nterminal proBrain Natriuremic Peptide) and troponin T levels were performed before and after the application of each cycle of chemotherapy. Echocardiography was performed before and after chemotherapy, as well as in the follow-up examinations every three months, a total of one year. Cardiac toxicity was determined based on the presence of cardiovascular symptoms, changes in the electrocardiogram, elevated levels of NTproBNP and troponin T and a decrease in left ventricular ejection fraction.

Results: In the study 184 patients (76.7%) were male. The most frequent was adenocarcinoma, in 120 patients (50%). Most common cardiovascular toxic effects were elevation in the level of NTproBNP (44.85%), cardiac arrhythmias (26.18%), venous thromboembolism (19.9%) and decreased left ventricular ejection fraction (6.96%). Patients treated with the first-line chemotherapy gemcitabine and cisplatin developed cardiotoxicity more frequently if they had a former history of cardiovascular diseases, but without statistical significance. In the group with paclitaxel and carboplatin, patients developed cardiotoxicity more frequently if they had a former history of cardiovascular diseases, and the statistical significance was registered at the first follow-up examination in stage III NSCLC patients (p=0.037).

Conclusion: Chemotherapy induced cardiotoxicity frequently occurs in patients with cardiovascular comorbidities. Early detection and adequate therapy of cardiotoxicity is crucial for substantial recovery of cardiac function. Balance between the effectiveness of chemotherapy and the risk of cardiotoxicity requires close cooperation oncologists and cardiologists.