Anthracyclines and Trastuzumab-induced cardiotoxicity in breast cancer patients: Testing a clinical risk score in the first Cardio-oncology unit in Morocco.


  • Krikez I Cardio-oncology unit, Cardiology deparment, University hospital center Ibn Rochd of Casablanca
  • Benmalek R Cardio-oncology unit, Cardiology deparment, University hospital center Ibn Rochd of Casablanca


Breast cancer, Trastuzumab, Anthracyclines, Cardiotoxicity, Clinical risk score, Cardio-oncology


Background : Recent advances in the early detection and treatment of cancer have led to a significant improvement of cancer survival worldwide. However, long-term cardiotoxic side effects affect both patient survival and quality of life.

Aim: To assess the utility of the Cardiotoxicity Risk Score (CRS) to predict cardiotoxicty among our patients.

Material and Methods : We conducted a prospective observational study for 3 years in the first cardio-oncology unit in Morocco. For each breast candidate to an adjuvant treatment with anthracyclines and/or  trastuzumab, we calculated The CRS proposed by the ASCO and classified the patients in 2 groups (high and low risk). We then performed sensivity and correlation analysis between cardiotoxicity and the patients’ CRS.

Results : In total, 413 patients were included, and when applying the CRS to them, 136 (32,9%) were considered at high risk and 277 (67,1%) at low risk. During follow-up, 42 patients (10,1%) experienced cardiotoxicity. Sensitivity analysis showed that the CRS applied to our population had a sensitivity of 83% [95% CI: 0.78, 0.92], of specificity of 65% [95% CI: 0.54, 0.71], with a positive predictive value of 21% [95% CI: 0.08, 0.39] and a negative predictive value of 97% [95% CI: 0.90, 0.99]. On the other hand, correlation analysis found a significant positive correlation with both transient and permanent cardiotoxicity.

Conclusion: The CRS demonstrated good sensitivity and negative predictive value for the development of cardiotoxicity in our population, suggesting that intensive cardiac monitoring may not have as much interest in low-risk patients that in high-risk patients.