Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death in women worldwide. Human epidermal growth factor receptor 2 (HER2) is overexpressed in 25-30% of invasive breast cancers and is associated with high mortality. In HER2+ patients, anthracycline (i.e. doxorubicin) chemotherapy is usually followed by treatment with trastuzumab, which has led to a dramatic improvement in survival. However, cardiovascular toxicity remains the most devastating complications of cancer treatments. In a recent large study, the adjusted 3-year incidence of congestive heart failure (CHF) or cardiomyopathy was 42% for HER2+ patients. To monitor for potential cardiotoxicity, left ventricular ejection fraction (LVEF) is monitored and if a decline in LVEF develops, therapy is withheld. However, an LVEF decline occurs very late, and significant myocardial injury may have already occurred by the time an LVEF decline is detected. Therefore, an early detection of cardiotoxicity will have significant clinical impact by enabling initiation of cardioprotective theapy to prevent development of CHF and allowing uninterrupted completion of cancer therapy; however currently there is no non-invasive method to detect subclinical cardiotoxicity. Recent advances in cardiac MR (CMR) allow non-invasive assessment of the degree of extracellular volume expansion, diffuse interstitial fibrosis, inflammation, and edema which are directly related to myocardial injury associated with chemotherapy. Therefore, we hypothesize that CMR can provide noninvasive, quantitative evidence of early cardiotoxicity associated with adjuvant therapy for HER2+ patients to devise personalized treatment planning for management of toxicity without interrupting the chemotherapy. We will perform both pre-clinical (in a swine model of cardiotoxicity) and clinical study (in HER2+ breast cancer patient) to establish role of CMR in detecting subclinical cardiotoxicity.

Public Health Relevance

Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death in women worldwide. Human epidermal growth factor receptor 2 (HER2) is overexpressed in 25-30% of invasive breast cancers and is associated with high mortality. In HER2+ patients, anthracycline (i.e. doxorubicin) chemotherapy is usually followed by treatment with trastuzumab, which has led to a dramatic improvement in survival. However, cardiovascular toxicity remains the most devastating complications of cancer treatments. In this proposal, we will investigate cardiac MR markers of cardiotoxicity and will investigate the incremental value of cardiac MR vs. echocardiography and serum biomarkers.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL127015-04
Application #
9657786
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Desvigne-Nickens, Patrice
Project Start
2016-03-15
Project End
2021-02-28
Budget Start
2019-03-01
Budget End
2020-02-29
Support Year
4
Fiscal Year
2019
Total Cost
Indirect Cost
Name
Beth Israel Deaconess Medical Center
Department
Type
DUNS #
071723621
City
Boston
State
MA
Country
United States
Zip Code
02215
Basha, Tamer A; Akçakaya, Mehmet; Liew, Charlene et al. (2017) Clinical performance of high-resolution late gadolinium enhancement imaging with compressed sensing. J Magn Reson Imaging 46:1829-1838
Bellm, Steven; Basha, Tamer A; Shah, Ravi V et al. (2016) Reproducibility of myocardial T1 and T2 relaxation time measurement using slice-interleaved T1 and T2 mapping sequences. J Magn Reson Imaging 44:1159-1167