The clinical utility of baseline cardiac assessments prior to adjuvant anthracycline chemotherapy in breast cancer: a systematic review and meta-analysis

Pierre O’Brien, Kara Matheson, Alwin Jeyakumar, Kim Anderson, Tallal Younis

Research output: Contribution to journalReview articlepeer-review

12 Citations (Scopus)

Abstract

Background: Cardiac assessment with multi-gated acquisition scan (MUGA) or echocardiography (ECHO) is commonly employed prior to adjuvant anthracycline-based chemotherapy (AA). However, the clinical utility of routine baseline cardiac assessments prior to AA for early-stage breast cancer (EBC) is unknown. Objectives: To determine: (i) the clinical utility of routine baseline cardiac assessments prior to AA for EBC and (ii) identify patients in whom baseline cardiac assessments may not be warranted. Methods: A systematic review of the literature was conducted to identify all relevant studies that met predefined criteria. The clinical utility was defined by: (i) the rates of abnormal baseline left ventricular ejection fraction (LVEF) and (ii) the rates of change in chemotherapy decisions prompted by baseline LVEF results. Results: Eight studies met our criteria, of whom six (n = 2545) reported rates of abnormal LVEF and six (n = 1713) reported rates of change in chemotherapy decision. Overall, 2.5% (95% CI 2.0–4.0%) of patients had abnormal baseline LVEF and 1.6% (95% CI 1.0–3.0%) had a change in chemotherapy decision. In subset analyses, the underlying imaging modality (ECHO vs. MUGA) or inclusion of patients with metastatic disease (YES vs. NO) did not significantly affect these rates. There were no consistently identified underlying predictors of abnormal baseline LVEF across studies. Conclusions: Routine baseline cardiac assessments prior to AA in all EBC patients have low yield and infrequently affect clinical management. Future studies should further examine potential predictors of abnormal cardiac functions in an attempt to identify low risk patients in whom routine baseline LVEF assessment may not be warranted and prevent delay in chemotherapy administration.

Original languageEnglish
Pages (from-to)357-363
Number of pages7
JournalBreast Cancer Research and Treatment
Volume174
Issue number2
DOIs
Publication statusPublished - Apr 15 2019
Externally publishedYes

Keywords

  • Anthracyclines
  • Breast cancer
  • Cardiotoxicity
  • Routine
  • Screening

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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