Heart Failure in Patients With Cancer Treated With Anthracyclines—Revisiting the Foundation of Cardio-Oncology
Menée à partir de données 1985-2010 portant sur 812 patients atteints d'un lymphome ou d'un cancer du sein (âge moyen : 52,6 ans) et sur 1 384 témoins, cette étude analyse le risque d'insuffisance cardiaque congestive en lien avec les traitements par anthracyclines
Adverse cardiovascular events are an increasingly recognized problem for patients with cancer and individuals in remission, associated with both the shared risk factors that exist between these diseases as well as from the cancer treatments themselves. While any form of cardiovascular disease can develop, significant attention has been given to congestive heart failure (CHF), also known as cancer treatment–related cardiac dysfunction (CTRCD), given its substantial impact on morbidity and mortality. Anthracyclines are a class of cancer therapeutics used to treat a variety of solid and hematologic malignant neoplasms and are associated with the development of CTRCD and CHF, particularly in a dose-dependent fashion; however, there remains significant uncertainty regarding its short- and long-term incidence. The study by Larsen and colleagues used a large population-based cohort from Olmsted County, Minnesota, as part of the Rochester Epidemiology Project, to better assess the cumulative incidence of CHF in patients with cancer, specifically breast cancer or lymphoma (predominantly non-Hodgkin). Compared with participants without cancer, those who had been treated for cancer had a higher risk of CHF even after adjusting for baseline characteristics, including age, sex, diabetes, hypertension, coronary artery disease, hyperlipidemia, obesity, and tobacco use (HR, 3.25; [95% CI, 2.11-5.00], P < .001), which persisted regardless of cancer type; however, this increased risk was primarily associated with anthracycline exposure. In fact, among patients with cancer who were not treated with anthracyclines, the risk of CHF was no longer statistically significant compared with healthy controls. Interestingly, there was also no significant difference in risk based on the cumulative dose of anthracycline. While several other studies evaluating the incidence of CHF in patients with cancer exposed to anthracyclines have published similar results, the study by Larsen et al is unique and distinctly adds to our understanding of the epidemiology of anthracycline-associated CHF, given the long-term follow-up and the inclusion of both patients with breast cancer and lymphoma. Moreover, Larsen et al define CHF using the modified Framingham criteria and performed manual record review to confirm the CHF diagnosis, which contributes to the reliability of the conclusions.
JAMA Network Open , commentaire, 2022