Strain vs. Left Ventricular Ejection Fraction-based Cardiotoxicity Prevention in Breast Cancer

Strain-based vs. Left Ventricular Ejection Fraction-based Cardiotoxicity Prevention Strategy in Patients With Breast Cancer Who Treated With Adjuvant Trastuzumab

Comparing preventive effect of myocardial global longitudinal strain-based cardioprotective stragety (angiotensin receptor blocker prophylaxis) with left ventricular ejection fraction-based strategy in breast cancer patients treated with adjuvant trastuzumab.

Despite the left ventricular global longitudinal strain (GLS) enables early prediction of trastuzumab-related cardiomyopathy, its clinical application has been hampered due to the lack of appropriate evaluation and treatment strategies. Therefore, we aimed to evaluate the effect of early intervention strategy (GLS-based cardiotoxicity monitoring and administration of candesartan) by comparing with conventional intervention strategy (left ventricular ejection fraction-based cardiotoxicity monitoring and administration of candesartan) in breast cancer patients who treated with adjuvant trastuzumab.

Inclusion Criteria:

• Female aged ≥ 18 years
• Pathologically confirmed HER2-positive breast cancer
• Adjuvant treatment plan comprises at least 12 cycles of Trastuzumab
• Baseline echocardiogram should be performed before starting trastuzumab
• Cumulative anthracycline dose ≤ 300mg/m2
• Written informed consent to participate in the study

Exclusion Criteria:

• History of hypersensitivity or alllergic reaction to the study medication
• Metastatic breast cancer
• Treatment with angiotensin converting enzyme(ACE) inhibitor , Angiotensin receptor blocker (ARB), beta-blocking agents, or diuretics
• Patients with NCI/CTCAE grade ≥ 2 congestive heart failure, myocardial infarction, symptomatic left ventricular systolic dysfunction, heart's valve disease (≥ moderate), arrhythmias (Grade ≥ 3) < 12 months before enrollment
• Pregnancy or breast feeding
• Baseline systolic pressure < 90mmHg
• Cumulative anthracycline dose > 300mg/m2
• Serious concurrent illness