124P - Cardiac events in stage III non-small cell lung cancer (NSCLC): An attention shift to cardio-oncology collaboration
- Juliette Degens (NL)
- Dirk De Ruysscher (NL)
- Bas Kietselaer (NL)
- Annemie Schols (NL)
- Anne-Marie C. Dingemans (NL)
- Juliette Degens (NL)
Abstract
Background
Recently it was shown that 15% of stage III NSCLC patients, treated with thoracic radiotherapy in dose-escalated trials, suffer from late cardiac events.1 However, the prevalence of pre-existent cardiac co-morbidity in daily clinical practice in these patients and the development of cardiac events during follow-up is still unclear. As these patients are treated with curative intent and have a five survival rate 25%, there is need for a study to investigate the development of cardiac events and the relation with pre-existent cardiac co-morbidity.
Methods
In this retrospective cohort study a thorough patient file search was carried out in 153 patients diagnosed with stage III NSCLC, treated with (chemo-)radiotherapy between 2006 and 2011 in our center. Primary endpoint was the incidence of pre-existing cardiac comorbidity and relation with the development of serious cardiac events, defined as CTCAE 4.0 grade >2, within five years after a curative treatment with (chemo)radiotherapy. Cardiovascular risk prediction was calculated for each patient according to WHO/ISH, which indicates the 10-year risk of a serious cardiovascular event.
Results
Pre-existing cardiac comorbidity was seen in 46 patients (31.1%) with most frequently myocardial infarct/ coronary artery disease (9.8%) and arrhythmia (7.8%). WHO/ISH cardiovascular risk prediction was > 10% in 60.1% of the patients. Serious cardiac events appeared in 26% of the patients in the second year after treatment (20.3%). Most frequent cardiac events were arrhythmia (9.2%), myocardial infarction (6.5%), congestive heart failure (4.6%) and pericardial effusion (4.6%).
Serious cardiac events within subgroups of the study population
| Total N = 153 | Cardiac history N = 46 | No cardiac history N = 102 | WHO/ISH Cardiac event risk > 10% N = 78 | |
|---|---|---|---|---|
| Cardiac events CTCAE-score > 2 (N/%) | 38 (26%) | 14 (30%) | 24 (23%) | 18 (23%) |
| Missing (N) | 7 | - | - | - |
| Median time to event 1–2 years (N/%) | 17 (11.6%) | 6 (13%) | 11 (10.8%) | 16 (20.5%) |
Conclusions
In daily clinical practice 1/3th of patients with stage III NSCLC, treated with (chemo-)radiotherapy, have pre-existing cardiac comorbidity. In addition, 26% develop a serious cardiac event during follow-up, even in patients without cardiac history. Therefor it is important to identify patients at risk in order to prevent these cardiac events.
Legal entity responsible for the study
Maastricht University Medical Center
Funding
Has not received any funding
Disclosure
D. De Ruysscher: Consulting or advisory role to disclose: Bristol-Myers Squibb I have research funding to disclose: Brsitol-Myers-Squibb (BMS). A-M. Dingemans: Reports other from Roche/Genentech, other from MSD Oncology, other from AstraZeneca, other from Pfizer, other from Lilly, other from Boehringer Ingelheim, other from Bristol-Myers Squibb, other from Clovis Oncology, outside the submitted work. All other authors have declared no conflicts of interest.
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