ABSTRACT
BACKGROUND: Long-term breast cancer survivors are at risk for cardiotoxicity after treatment, but there is insufficient evidence to provide long-term (~10 years) cardiovascular disease (CVD) screening recommendations. We sought to evaluate a tri-modality CVD screening approach. METHODS: This single-arm, feasibility study enrolled 201 breast cancer patients treated ≥6 years prior without CVD at diagnosis. Patients were sub-grouped: cardiotoxic (left-sided) radiation (RT), cardiotoxic (anthracycline-based) chemotherapy, both cardiotoxic chemotherapy and RT, and neither cardiotoxic treatment. Patients underwent electrocardiogram (EKG), transthoracic echocardiogram with strain (TTE with GLS), and coronary artery calcium computed tomography (CAC CT). The primary endpoint was preclinical or clinical CVD. RESULTS: Median age was 50 (29-65) at diagnosis and 63 (37-77) at imaging; median interval was 11.5 years (6.7-14.5). Among sub-groups, 44% had no cardiotoxic treatment, 31.5% had cardiotoxic RT, 16% had cardiotoxic chemotherapy, and 8.5% had both. Overall, 77.6% showed preclinical and/or clinical CVD and 51.5% showed clinical CVD. Per modality, rates of any CVD and clinical CVD were, respectively: 27.1%/10.0% on EKG, 50.0%/25.3% on TTE with GLS, and 50.8%/45.8% on CAC CT. No statistical difference was seen among the treatment subgroups (NS, χ2 test, p = 0.58/p = 0.15). CONCLUSION: This study identified a high incidence of CVD in heterogenous long-term breast cancer survivors, most >10 years post-treatment. Over half had clinical CVD findings warranting follow-up and/or intervention. Each imaging test independently contributed to the detection rate. This provides early evidence that long-term cardiac screening may be of value to a wider group of breast cancer survivors than previously recognized.
Subject(s)
Cancer Survivors , Cardiotoxicity/diagnostic imaging , Unilateral Breast Neoplasms/drug therapy , Unilateral Breast Neoplasms/radiotherapy , Adult , Aged , Anthracyclines/adverse effects , Antineoplastic Agents/adverse effects , Cardiotoxicity/epidemiology , Cardiotoxicity/etiology , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/epidemiology , Coronary Disease/diagnostic imaging , Coronary Disease/epidemiology , Echocardiography/methods , Electrocardiography/methods , Feasibility Studies , Female , Heart/drug effects , Heart/radiation effects , Humans , Middle Aged , Radiotherapy/adverse effects , Regression Analysis , Risk Factors , Time Factors , Tomography, X-Ray Computed , Vascular Calcification/diagnostic imaging , Vascular Calcification/epidemiologyABSTRACT
This article deals with compulsory licensing scenarios in India, provides a background of relevant provisions in the Patents Act and examines how these provisions are Trade-Related Aspects of Intellectual Property Rights compliant. This article further discusses the procedure followed by India in granting a compulsory license, provides an overview of compulsory license applications filed in India to date and judicial precedence regarding the same. This article also highlights how compulsory licensing is a great safeguard that balances the interests of the innovators and the public at large.
