Abstract P3-15-11: Chemotherapy-related fatigue in low cardiac risk breast cancer patients: A sign of cardiotoxicity?
Authors: Marfatia R , Inyangetor D , Feinn RS , Adekolu O , Fellows D , Tannenbaum S , Avelar E 
Published: August 2014

BACKGROUND: Fatigue in breast cancer patients receiving chemotherapy is a common occurrence and is related to multiple factors. Limited studies exist regarding fatigue as an early symptom of cardiotoxicity.

HYPOTHESIS: Fatigue will occur in a majority of early stage breast cancer patients receiving adjuvant chemotherapy despite normal systolic function by echocardiogram and cardiac magnetic resonance imaging (CMR).

METHODS: We prospectively enrolled 20 patients with stage I-IIb breast cancer undergoing adjuvant anthracycline or trastuzumab based chemotherapy. Mean age 49 ± 12 years. Seventeen patients completed all 4 time points. CMR, echocardiography and cardiac biomarkers were obtained at 4 different time-points: baseline, during chemotherapy and then 2 weeks and 6 months after completion of chemotherapy. A heart failure questionnaire was completed at each time point with physical examination. Statistics were analyzed by a linear mixed model.

RESULTS: Symptoms of fatigue increased during chemotherapy but did not reach statistical significance (table 1). CMR detected significant increases in LV end-diastolic and end-systolic volumes and a significant decrease LV ejection fraction (table2). Biomarkers of cardiac injury troponin I, c-reactive protein, and brain natriuretic peptide did not change significantly.

CONCLUSION: Transient fatigue occurred in a majority of patients during chemotherapy but was not clinically significant. However, transient increases in volumetric size did reach statistical significance and paralleled fatigue symptoms. These changes may indicate early cardiotoxicity.

SYMPTOM AND CLINICAL RESPONSE TO CHEMOTHERAPYVariableBaselineAfter 2nd Cycle of Chemotherapy2 Weeks After Last Cycle of Chemotherapy6 Months After Last Cycle of ChemotherapyP ValueSYMPTOMATOLOGY     Fatigue (%)0.0047.3421.0510.530.112Chest Pain (%)5.265.265.265.261.000Palpitations (%)10.5310.535.265.260.392Dyspnea (%)0.0010.5310.530.000.801Edema (%)0.000.005.260.000.392PND (%)0.005.260.000.000.392CLINICAL     SBP (mmHg)118.50 ± 11.06116.00 ± 14.06116.53 ± 12.22114.86 ± 6.930.605DBP (mmHg)71.00 ± 8.0669.89 ± 8.7470.93 ± 8.3571.21 ± 7.840.880PP (mmHg)47.50 ± 11.4946.11 ± 12.7442.75 ± 14.4243.64 ± 8.730.841Weight (kg)72.14 ± 14.3172.44 ± 15.4072.50 ± 14.9470.14 ± 13.090.924

IMAGING AND BIOMARKERS DURING CHEMOTHERAPYVariableBaselineAfter 2nd Cycle of Chemotherapy2 Weeks After Last Cycle of Chemotherapy6 Months After Last Cycle of ChemotherapyP VALUECARDIAC MRI PARAMETERS     EDV (ml/m2)71.03 ± 10.9775.10 ± 10.3476.03 ± 10.8574.74 ± 12.610.070ESV (ml/m2)25.78 ± 6.6328.83 ± 5.3330.82 ± 5.2429.75 ± 6.890.000      EDV (ml)124.73 ± 20.25133.13 ± 22.83136.21 ± 22.20132.214 ± 19.330.035ESV (ml)45.16 ± 11.8851.044 ± 11.0455.09 ± 10.0752.57 ± 11.650.000      MM(at ED) (gm)73.06 ± 11.5172.93 ± 18.1269.90 ± 13.8869.21 ± 15.130.827MM(at ED) (g/m2)41.64 ± 6.7441.11 ± 9.1538.79 ± 5.4938.61 ± 6.650.603            EF (%) (CARDIAC MRI)64.15 ± 5.3061.71 ± 4.3459.37 ± 4.6460.41 ± 5.770.000EF (%) (BIPLANE 2D ECHOCARDIOGRAM)65.38 ± 7.4266.55 ± 6.4061.86 ± 4.8260.57 ± 6.150.051      BIOMARKERS     Troponin I (ng/mL)0.012 ± 0.010.015 ± 0.020.015 ± 0.010.019 ± 0.040.312NTproBNP (pg/L)45.73 ± 49.8940.60 ± 35.8754.91 ± 59.2436.71 ± 32.370.704CRP (mg/L)3.707 ± 4.505.28 ± 6.425.64 ± 10.513.06 ± 4.110.324

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-15-11.