Home
Sessions
Evolving Paradigms in High-Risk Breast Cancer: Optimization and Integration of Treatment Modalities Across the Disease Continuum
Association of Baseline Cardiac Risk Factors, Patient and Treatment Variables with Cardiac Adverse Events (AE) for Early-Stage Breast Cancer Patients on NRG Oncology RTOG 1005 (NRG/R1005) Clinical Trial

Sep 29

SS 40 - Evolving Paradigms in High-Risk Breast Cancer: Optimization and Integration of Treatment Modalities Across the Disease Continuum

319 - Association of Baseline Cardiac Risk Factors, Patient and Treatment Variables with Cardiac Adverse Events (AE) for Early-Stage Breast Cancer Patients on NRG Oncology RTOG 1005 (NRG/R1005) Clinical Trial

03:55pm - 04:05pm ET

Room 253

Presenter(s)

Julia White, MD, FASTRO - University of Kansas Cancer Center, Kansas City, KS

J. R. White¹, K. Winter², F. A. Vicini³, G. M. Freedman⁴, W. A. Woodward⁵, Y. Xiao⁶, V. Stearns⁷, T. Safder⁸, H. Geng⁹, D. W. Arthur¹⁰, A. G. Taghian¹¹, J. Lyons¹², J. K. Tomberlin¹³, S. A. Seaward¹⁴, S. Cheston¹⁵, B. M. Anderson¹⁶, F. E. Perera¹⁷, D. Shumway¹⁸, M. M. Poppe¹⁹, and E. P. Mamounas²⁰; ¹University of Kansas Comprehensive Cancer Center, Kansas City, KS, ²NRG Oncology Statistics and Data Management Center, Philadelphia, PA, ³Michigan Health Professionals, Farmington Hills, MI, ⁴Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, ⁵MD Anderson Cancer Center, Houston, TX, ⁶Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, ⁷NYP/ Weill Cornell Medical Center, New York, NY, ⁸University of Kansas Medical Center, Kansas City, KS, ⁹University of Pennsylvania, Perlman School of Medicine, Philadelphia, PA, ¹⁰Virginia Commonwealth University and Massey Comprehensive Cancer Center, Richmond, VA, ¹¹Harvard Medical School, Boston, MA, ¹²University Hospitals Seidman Cancer Center / Case Western Reserve University, Cleveland, OH, ¹³US Oncology Research, The Woodlands, TX, ¹⁴Kaiser Permanente Oncology Clinical Trials, Vallejo, CA, ¹⁵Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, ¹⁶University of Wisconson School of Medicine and Public Health, Madison, WI, ¹⁷London Health Sciences Centre/Western University, London, ON, Canada, ¹⁸Department of Radiation Oncology, Mayo Clinic, Rochester, MN, ¹⁹Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, ²⁰AdventHealth Cancer Institute, Orlando, FL

Purpose/Objective(s):

Breast cancer (BC) survivors have a higher risk of cardiovascular disease (CVD) exceeding that of women without BC. With contemporary whole breast irradiation (WBI) delivery, the extent of residual CVD risk that exists and may benefit from risk-adapted surveillance/ prevention is unanswered and without a standard assessment method. A secondary endpoint of the NRG/R1005 trial evaluated baseline cardiac risk factors (RF) on subsequent cardiac AE occurrence.

Materials/Methods:

Analysis included eligible patients who received protocol treatment, had AE data, and completed baseline Cardiac RF Form. Cardiac AE per CTCAE v.4 regardless of attribution were grouped as yes (any grade) vs none. Univariate logistic regression models identified any associations between cardiac AE occurrence, baseline cardiac and comorbidity/smoking history RF, and other pretreatment, tumor, and treatment variables. 9 baseline cardiac RF (coronary disease, valvular disease, A-fib, arrhythmia, angina, MI, CHF, stroke, hypertension [HTN]) and 7 comorbid RF (pulmonary HTN, COPD, diabetes, high cholesterol, renal insufficiency, anemia, smoking) were analyzed individually then by grouping, None vs. 1 RF vs. =2 RF. Multivariable logistic regression models were performed with treatment arm, pretreatment/tumor characteristics (univariate p-value<0.05), and RF groupings to identify association with cardiac AE.

Results:

NRG/R1005 randomized 2354 patients from 2011-2014 intending WBI without nodal irradiation to sequential (n=1169) or concurrent boost (n=1185); this analysis includes 897 and 920 in each arm, respectively. Median follow-up is 7.7 years. Median age 54, white race 79%, LEFT breast 50%, and mean heart dose 1.58 Gy [1.26 SD]. No cardiac RF present in 63%, 1 in 32%, and =2 in 5%. No co-morbid RF in 44%, 1 RF 40%, =2 RF 16%. Never smokers 57%, =20 pack year 15%. 127 (7%) cardiac AE were reported (Grade 1: 3%, 2: 2%, 3: 2%, 4: 0.2%) with chest pain, palpitations, A Fib, CHF, arrhythmia most prevalent. On univariate analysis, age =50 is the only patient, tumor, or treatment variable associated with more cardiac AE, 8% vs 5% (OR 1.58 [1.06-2.36], p=0.026). No difference by left (6.4%) vs right (7.6%) side WBI (OR 0.84 [0.58-1.20], p=0.34). Presence/ number of cardiac or comorbid RF is associated with increasing cardiac AE.

Abstract 319 – Table 1

Conclusion:

Baseline cardiac RF was the dominant predictor of Cardiac AE and routine assessment prior to receipt of WBI identified patients that may benefit from referral to CVD prevention programs

		Univariate			Multivariable
	Cardiac AE %	OR	CI	p	OR	CI	p
Cardiac RF 0	5%	ref	..	..	ref	..	..
1	8%	1.77	1.19-2.64	0.005	1.69	1.11-2.55	0.013
=2	28%	7.55	4.39-12.99	<0.001	7.13	4.08-12.48	<0.001
CoMorbid RF 0	6%	ref	..	..	ref	..	..
1	7%	1.07	0.71-1.61	0.75	1.03	0.68-1.55	0.89
=2	10%	1.68	1.04-2.71	0.034	1.51	0.93-2.47	0.097