Abstract 12849: Assessing Cardiovascular Toxicity in Cancer Treatment: Validation of the Heart Failure Association and International Cardio-Oncology Society Tool Using Prospective Registry Data

Introduction: Cancer treatment-related cardiovascular toxicity (CTR-CVT) is a growing concern in patients undergoing anticancer therapy. The Heart Failure Association (HFA) and International Cardio-Oncology Society (ICOS) risk assessment tools have been proposed for the baseline cardiovascular (CV) risk stratification of patients with cancer. This study examined the incidence of adverse CV events associated with cancer treatment in clinical practice, also using the HFA-ICOS risk assessment tool.

Methods: This single-center, prospective, observational study was conducted at Kurume University Hospital between October 2016 and August 2021 in patients aged ≥20 years with hematologic malignancies or breast cancer who were receiving anticancer agents. CV assessments were performed at enrollment and every 6 months until February 2022, with additional assessments for suspected CV adverse events. The primary endpoint was adverse CV event as defined by Common Terminology Criteria for Adverse Events (CTCAE) v4.0 grade ≥2, and the secondary endpoints were all-cause and CV death.

Results: Of the enrolled 486 patients, adverse CV events occurred in 24.5% of patients with leukemia, 15.8% of patients with malignant lymphoma, 38.1% of patients with multiple myeloma, and 18.0% of patients with breast cancer, respectively. Kaplan-Meier curves of the primary endpoint and heart failure (HF)/ left ventricular (LV) dysfunction stratified by HFA-ICOS risk assessment group have shown the significant worse events in high/very high-risk group, in which the hazard ratios in the high/very high-risk group compared to the low-risk group were 2.34 (95% CI 1.48-3.71, p<0.001) in the primary endpoint and 3.57 (95% CI 1.70-7.51, p<0.001) in HF/LV dysfunction. There was no significant difference in the event risk between the low- and moderate-risk groups. CV death occurred in 4 patients (0.8 %) during follow-up.

Conclusions: This study showed that 16-38% of patients with hematologic malignancies and breast cancer developed CTR-CVT during follow-up, in which high/very high-risk patients were well predicted by the HFA-ICOS risk assessment tool. The monitoring and managing CV risk factors are essential for safe cancer therapy.