A Meta-Analysis of Incidence and Risk Factors of Trastuzumab-Induced Cardiotoxicity in Breast Cancer

Jawa, Zeeshan; Perez, Ruth M; Garlie, Lydia; Singh, Maharaj; Qamar, Rubina; Khandheria, Bijoy K.; Jahangir, Arshad; Yang, Shi

doi:10.17294/2330-0698.1229

Cited by 18 publications

(20 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Cardiologists were more likely than oncologists to recommend early referral of cancer patients to a cardio-oncology clinic. Studies have shown that patients with one or more cardiovascular risk factors are more likely to experience a cardiac event when exposed to cancer therapy [20,21]. Anthracyclines, a cornerstone of cancer treatment, are associated with increased risk of irreversible cardiotoxicity, and ultimately, cardiomyopathy [22].…”

Section: Discussionmentioning

confidence: 99%

An international survey of healthcare providers’ knowledge of cardiac complications of cancer treatments

et al. 2019

View full text Add to dashboard Cite

Background: Cardio-oncology is a young sub-specialty that addresses the needs of cancer patients at risk of, or who have experienced cancer therapy related cardiac dysfunction (CTRCD). This study assessed clinicians' understanding of cardio-oncology, opinions towards current practice, and approach to diagnosing and managing CTRCD. Methods: A 45-question survey was administered online via Survey Monkey and WeChat to health care providers (HCPs) comprising of cardiologists, oncologists, and others from September 2017 to March 2018. Implementation of the survey followed a modified Dillman's Total Design Method. Results: In total, 160 responses were collected from 22 countries; majority were from cardiologists (53.8%) and oncologists (32.5%). The remaining 13.7% identified themselves as "others," including general internists, cardiooncologists, pediatric oncologists, radiation oncologists, cardiac rehabilitation therapists, nurse practitioners, research students, and pharmacists. In the setting of metastatic cancer, there was a difference in risk tolerance for cardiotoxicity between subspecialties. In this case, more cardiologists (36.7%) accepted a 5-10% risk of cardiotoxicity compared to oncologists (20.0%). Majority of cardiologists felt that cardiotoxicity should be monitored, even in asymptomatic cancer patients (55.8%). Only 12% of oncologists selected this response. In contrast, 50.0% of oncologists reported that cardiologists should be involved only when patients develop cardiotoxicity. In comparison, 6.5% of cardiologists selected this response. Majority of cardiologists stated that cardio-oncology clinics would significantly improve cancer patients' prognosis (88.3%); only 45.8% of oncologists shared this opinion. Of all respondents, 66.9% stated they were familiar with a variety of international guidelines for managing cardiotoxicity. Of all oncologists, 65.3% indicated that they referred to these guidelines for clinical decision making. Conclusions: Despite the growth of cardio-oncology clinics, there are significant knowledge gaps regarding prevention and treatment strategies for CTRCD among health care providers. Knowledge translation from guidelines and collaboration between cardiologists and oncologists are needed to improve cardiovascular outcomes of cancer patients.

show abstract

Section: Discussionmentioning

confidence: 99%

An international survey of healthcare providers’ knowledge of cardiac complications of cancer treatments

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Baseline CV risk assessment proformas have been developed for seven cardiotoxic cancer therapy classes known to cause a range of CV toxicities including left ventricular dysfunction (LVD) and HF ( Tables 2–8 ). 10–68 The risk is estimated for all CV complications from the drug class, e.g. left ventricular dysfunction, QTc prolongation and arrhythmias, vascular events including myocardial infarction (MI) and hypertension: Anthracycline chemotherapy : the main CV complications of anthracycline chemotherapy are LVD and HF, and atrial and ventricular arrhythmias 19,69 …”

Section: Design and Application Of Baseline Cardiovascular Risk Profomentioning

confidence: 99%

Baseline cardiovascular risk assessment in cancer patients scheduled to receive cardiotoxic cancer therapies: a position statement and new risk assessment tools from the Cardio‐Oncology Study Group of the Heart Failure Association of the European Society of Cardiology in collaboration with the International Cardio‐Oncology Society

Lyon

Dent

Stanway

et al. 2020

European J of Heart Fail

397

175

View full text Add to dashboard Cite

This position statement from the Heart Failure Association of the European Society of Cardiology Cardio‐Oncology Study Group in collaboration with the International Cardio‐Oncology Society presents practical, easy‐to‐use and evidence‐based risk stratification tools for oncologists, haemato‐oncologists and cardiologists to use in their clinical practice to risk stratify oncology patients prior to receiving cancer therapies known to cause heart failure or other serious cardiovascular toxicities. Baseline risk stratification proformas are presented for oncology patients prior to receiving the following cancer therapies: anthracycline chemotherapy, HER2‐targeted therapies such as trastuzumab, vascular endothelial growth factor inhibitors, second and third generation multi‐targeted kinase inhibitors for chronic myeloid leukaemia targeting BCR‐ABL, multiple myeloma therapies (proteasome inhibitors and immunomodulatory drugs), RAF and MEK inhibitors or androgen deprivation therapies. Applying these risk stratification proformas will allow clinicians to stratify cancer patients into low, medium, high and very high risk of cardiovascular complications prior to starting treatment, with the aim of improving personalised approaches to minimise the risk of cardiovascular toxicity from cancer therapies.

show abstract

“…We recognise some limitations of this meta-analysis, mainly the impossibility to extract cardiac outcomes on a patient-level data. This precludes the analysis of cardiac outcomes according to the exposition (and cumulative doses) to anthracyclines, a known risk factor for cardiotoxicity with trastuzumab treatment,33 45 for which different levels of exposition per treatment arm may have occurred in SHORT-HER 6. No cardiac death analyses could be performed since only PERSEPHONE reported very few events in great detail 3.…”

Section: Discussionmentioning

confidence: 99%

Cardiotoxicity of trastuzumab given for 12 months compared to shorter treatment periods: a systematic review and meta-analysis of six clinical trials

et al. 2020

View full text Add to dashboard Cite

BackgroundTreatment de-escalation in early-stage, human epidermal growth factor receptor 2 (HER2)-positive breast cancer (BC) has been attempted in order to decrease costs and toxicities. One of the strategies pursued is decreasing trastuzumab treatment duration, with mixed results thus far. Trastuzumab-associated cardiotoxicity, however, may be more frequent with 12 months of trastuzumab compared with shorter treatment lengths. Therefore, we have conducted a meta-analysis to address this question.Materials and methodsA meta-analysis of trials testing 12 months of adjuvant trastuzumab versus shorter regimens, reporting cardiac outcomes in patients with HER2-positive BC was performed with the random effects model with inverse variance weighting.ResultsClinical cardiac dysfunction associated with 12 months of trastuzumab versus shorter trastuzumab regimens, including 11 250 patients, showed a pooled OR (pOR) of 1.90 (95% CI 1.37 to 2.64; p value <0.001; I2=65.7%); in the subgroup comparison of 12 versus 6 months, the pOR was 1.57 (95% CI 1.30 to 1.90; p<0.001; I2=5.7%). pOR for low left ventricular ejection fraction was 1.45 (95% CI 1.19 to 1.75; p<0.001; I2=11.9%), 1.55 (95% CI 1.00 to 2.42; p=0.052; I2=0.0%) for congestive heart failure and 3.70 (95% CI 0.27 to 51.60; p=0.33; I2=78.8%) for premature trastuzumab discontinuation due to cardiotoxicity for 12 months versus shorter trastuzumab regimens. Funnel plot analyses indicated a low risk of publication bias.ConclusionsCompared to shorter treatment durations, there is sufficient evidence that 12 months of trastuzumab yields higher odds for the occurrence of relevant cardiac events. An individual patient-level data meta-analysis is needed in order to provide adequate data on risk factors for cardiotoxicity.

show abstract

A Meta-Analysis of Incidence and Risk Factors of Trastuzumab-Induced Cardiotoxicity in Breast Cancer

Cited by 18 publications

References 0 publications

An international survey of healthcare providers’ knowledge of cardiac complications of cancer treatments

An international survey of healthcare providers’ knowledge of cardiac complications of cancer treatments

Cardiotoxicity of trastuzumab given for 12 months compared to shorter treatment periods: a systematic review and meta-analysis of six clinical trials

Contact Info

Product

Resources

About