Monitoring of cancer therapeutics-related cardiac dysfunction with echocardiography and cardiac biomarkers in patients with gastric cancer

2021 Fiscal Year Final Research Report

• Project/Area Number: 17K09540
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Research Field: Cardiovascular medicine
• Research Institution: Japanese Foundation for Cancer Research
• Principal Investigator: WATANABE Atai 公益財団法人がん研究会, 有明病院 総合診療部, 副医長 (00597271)
• Project Period (FY): 2017-04-01 – 2022-03-31
• Keywords: 薬剤性心筋症 / トラスツズマブ / 胃がん

Outline of Final Research Achievements

The purpose of this study is to determine the relationships between echocardiographic and clinical parameters and cancer therapeutics-related cardiac dysfunction (CTRCD) in patients with gastric cancer received chemotherapy with/without trastuzumab (Tras).
Of the 51 patients, 4 (7.8%) developed CTRCD (3 with Tras (12.5%) vs 1 without Tras (3.7%)). With Tras, change of left ventricular ejection fraction (LVEF) was decreased as compared with that of control group. (Tras group -6.0% vs control group 1.5%, P=0.001). Medical history of heart diseases, larger left ventricular (LV) dimension and lower LVEF were associated with development of CTRCD in Tras group (P<0.05 for all).
Cardiac toxicity of Tras has been evaluated in breast cancer patients. In this study, a similar LVEF decline was observed in patients with gastric cancer. Furthermore, a lower systolic function of LV was predictive of CTRCD. Our findings may suggest a strategy to identify high-risk patients prior to Tras therapy.

Free Research Field

循環器内科学

Academic Significance and Societal Importance of the Research Achievements

これまで、トラスツズマブの心毒性に関する研究は、主に対象患者数の多い乳がん患者で行われており、胃がんでの検討は少ない。胃がん患者では、乳がん患者に比べ、基礎疾患の罹患率が高い高齢者が多い。一方、アントラサイクリン系薬剤との併用投与は行われない。今回の検討で、胃がんにおいても、乳がん患者での報告と同程度の左室駆出率の低下が示された。また、トラスツズマブ投与群において、治療開始前に、心疾患の既往があり、左室収縮指標が低下傾向を示す症例は、薬剤性心筋症を高率に発症する可能性が示唆された。本研究は、胃がん患者におけるトラスツズマブの心毒性の事前予測や早期診断のための判断基準のひとつとなる可能性がある。