A NEW score to assess the risk of anthracycline-induced cardiovascular toxicity has been developed by researchers. The Heart Failure Association (HFA) and International Cardio-Oncology Society (ICOS) score, aims to classify the risk of cancer therapy-related cardiac dysfunction (CTRCD) in patients treated with anthracycline.
Recent studies have shown that CTRCD, such as symptomatic heart failure, or a reduction in left ventricular ejection fraction to <40% adversely affects the prognosis of cancer patients, with a significant increase in all-cause mortality. Therefore, researchers aimed to identify these high-risk patients and prevent CTRCD, without delaying or altering cancer treatment with anthracycline. The anthracycline HFA-ICOS risk score is based on the following variables: previous cardiovascular disease, prior cardiotoxic cancer treatment, elevated baseline cardiac biomarkers, demographics, and medical and lifestyle CVRF.
The study included 1,066 patients from the CARDIOTOX registry who received anthracycline treatment. Patients were predominantly female (81.9%) with a mean age of 54 ± 14 years. Patients were classified as low (53.6%), moderate (31.2%), high (14.3%), or very high risk (0.9%) based on their HFA-ICOS score. Over a median follow-up of 54.8 months, 197 patients (18.4%) died, and 718 (67.3%) developed CTRCD. Incidence rates of symptomatic or moderate to severe CTRCD and all-cause mortality were significantly higher in patients with higher HFA-ICOS scores (hazard ratio [HR]:28.74; 95% CI: 9.33–88.5; p<.001). And the same was true for very high-risk patients (HR: 7.43; 95% CI: 3.21–17.2; p<.001).
Overall, the predictive model exhibited strong calibration and discrimination for predicting symptomatic or severe/moderate asymptomatic CTRCD at 12 months (Brier score: 0.04; 95% CI: 0.03–0.05; area under the curve: 0.78; 95% CI: 0.70–0.82; Uno’s C-statistic: 0.78; 95% CI: 0.71–0.84).
This study concludes that the HFA-ICOS score is a valuable tool for stratifying cardiovascular toxicity risk in anthracycline-treated patients, with significant predictive power for identifying those at high risk of severe cardiac events and mortality. Future considerations should focus on integrating this score into broader cardio-oncology protocols, potentially improving outcomes through early identification and management of at-risk patients. Further studies could explore refining the score to enhance its accuracy and applicability across diverse patient populations.
Katrina Thornber, EMJ
Reference
Rivero-Santana B et al. Anthracycline-induced cardiovascular toxicity: validation of the Heart Failure Association and International Cardio-Oncology Society risk score. Eur Heart J. 2024;DOI:10.1093/eurheartj/ehae496.
