Anthracyclines and Trastuzumab-induced Cardiotoxicity in Breast Cancer Patients: Testing a Clinical Risk Score in the First Cardio-Oncology Unit in Morocco

Abstract

Background: Recent advances in the early detection and treatment of cancer have led to a significant
improvement of cancer survival worldwide. However, long-term cardio-toxic side effects affect both
patient survival and quality of life.
Aim: To assess the utility of the Cardio-toxicity Risk Score (CRS) to predict cardio-toxicity among our
patients.
Material and Methods: We conducted a prospective observational study for 3 years in the first
cardio-oncology unit in Morocco. For each breast cancer candidate to an adjuvant treatment with
anthracyclines and/or trastuzumab, we calculated The CRS proposed by the ASCO, and classified
the patients in 2 groups (high and low risk). We then performed sensitivity and correlation analysis
between cardio-toxicity and the patients’ CRS.
Results: In total, 413 patients were included, and when applying the CRS to them, 136 (32.9%) were
considered at high risk and 277 (67.1%) at low risk. During follow-up, 42 patients (10.1%) experienced
cardio-toxicity. Sensitivity analysis showed that the CRS applied to our population had a sensitivity
of 83% [95% CI: 0.78, 0.92], a specificity of 65% [95% CI: 0.54, 0.71], with a positive predictive value
of 21% [95% CI: 0.08, 0.39] and a negative predictive value of 97% [95% CI: 0.90, 0.99]. On the other
hand, correlation analysis found a significant positive correlation with both transient and permanent
cardio-toxicity.
Conclusion: The CRS demonstrated good sensitivity and negative predictive value for the
development of cardio-toxicity in our population, suggesting that intensive cardiac monitoring may
not have as much interest in low-risk patients that in high-risk patients.