SPC365

The delicate balance of permissive cardiotoxicity strategy in cancer-related cardiac dysfunction at a Tertiary Centre: a comparative analysis

Session: SESSÃO DE POSTERS 11 - CARDIONCOLOGIA DE PONTA II
Speaker: Leonor Magalhães

Congress: CPC 2025
Topic: K. Cardiovascular Disease In Special Populations
Theme: 30. Cardiovascular Disease in Special Populations
Subtheme: 30.6 Cardio-Oncology
Session Type: Cartazes
FP Number: ---
Authors: Leonor Magalhães; Ricardo Carvalheiro; Isabel Cardoso; Vera Vaz Ferreira; Tânia Branco Mano; Sónia Oliveira; Leonor Fernandes; Luís Almeida Morais; Boban Thomas; Rui Cruz Ferreira

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Cancer therapy-related cardiac dysfunction (CTRCD) is a common cause of early suspension of chemotherapy (QT), potentially impacting survival rates. Permissive cardiotoxicity emphasizes the continuation of cancer treatments while managing cardiotoxic effects. This study assesses clinical outcomes in patients with CTRCD undergoing a permissive strategy. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Methods</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">: Retrospective analysis of outpatients (P) with CTRCD referred to a cardio-oncology outpatient clinic at tertiary centre from April 2021 to December 2023.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Results</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">: 110P were diagnosed with CTRCD, of these 31P underwent permissive cardiotoxicity strategy. 61% were female and median age of 59 years (IQR 54-69). 65% had 2 or more cardiovascular risk factors and 4P presented pre-existing reduced ejection fraction HF. Breast cancer and haematological malignancies accounted for 77% cases, 48% were stage IV. The majority of cardiotoxic QT regimens included HER2-targeted agents, alkylating agents, and taxanes. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">68% developed asymptomatic CTRCD. The baseline median LVEF was 60% (IQR 54&ndash;64), which declined to a minimum of 49% (IQR 45&ndash;54). All patients started cardioprotective therapy (74% were treated with 3 or 4 classes of foundational HF prognosis-modifying drugs; 29% treated with sacubitril/valsartan).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Over a median follow-up of 13 months, 20P continued their planned QT (Subgroup A), while 11 discontinued treatments later (Subgroup B). In Subgroup B, only 3P stopped due to severe symptomatic CTRCD. Comparative analysis showed that older age, male sex, hypertension</span></span><span style="font-size:8.0pt">[VVF1]&nbsp;</span><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"> and pre-existing HF were associated with QT suspension (p&lt;0.05).&nbsp; Although Subgroup B had a higher incidence of NT-proBNP elevation (p=0.012) and lower median minimum LVEF (p=0.008), the relative impairment from baseline did not differ significantly between subgroups. In Subgroup B, 7P (64%) died after QT suspension, with a median survival of 152 days after suspension. In contrast, no deaths or significant cardiac events were reported in Subgroup A, and 13P (42%) already completed prescribed oncological therapy.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Conclusion</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">: In this cohort under permissive cardiotoxicity strategy, 9% experienced severe CTRCD, leading to suspension of QT; 42% resumed oncologic treatment with no mortality. A permissive cardiotoxicity approach enabled more patients to complete life-saving treatments. The current HF guideline-directed medical therapy and specialized cardio-oncology care may facilitate permissive cardiotoxicity strategies for potentially improved outcomes.</span></span></span></span></p>