A Prospective Cohort Study on Cardiotoxicity of Adjuvant Trastuzumab Therapy in Breast Cancer Patients

Matos, Erika; Jug, Borut; Blagus, Rok; Zakotnik, Branko

doi:10.5935/abc.20160084

Cited by 16 publications

(17 citation statements)

References 37 publications

(62 reference statements)

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“…Previous studies have suggested that tamoxifen has a protective effect on cardiac function (31), whereas Herceptin treatment may be cardiotoxic (32). However, there was no such evidence of either tamoxifen-mediated cardiac protection or Herceptin-mediated cardiotoxicity in the study, in agreement with other previous studies (33,34). It may be the case that compared with the chemotherapy, both the protective effects of tamoxifen and the cardiotoxic effects of Herceptin were too weak to discern in these patients (35).…”

Section: Discussionsupporting

confidence: 87%

BNP as a marker for early prediction of anthracycline‑induced cardiotoxicity in patients with breast cancer

Zhao

Chen

et al. 2019

Oncol Lett

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Anthracycline chemotherapy serves an important role in treating patients with breast cancer but is associated with cardiotoxicity. Although brain natriuretic peptide (BNP) is not the ideal marker for detecting the presence of diseases of the heart, several studies have demonstrated the predictive utility of BNP in the diagnosis of anthracycline-induced cardiotoxicity (AIC). The aim of the present study was to evaluate the role of BNP as a marker for the early prediction of AIC in patients with breast cancer. In the present study, a total of 149 patients with breast cancer who received anthracycline therapy were evaluated. The levels of BNP and echocardiography were detected during the anthracycline-based chemotherapy and patients were followed up after chemotherapy to determine the cardiotoxicity-free survival times. In the patients who received chemotherapy, an increase in the levels of BNP was observed. The concentration of BNP was significantly higher in the cardiotoxicity group during anthracycline chemotherapy (P=0.022) compared with the non-cardiotoxicity group and it was an independent predictor of cardiotoxicity (P=0.028). The optimal diagnostic threshold of BNP after the last anthracycline chemotherapy treatment was 107.9 pg/ml, the diagnostic sensitivity was 0.538, the specificity was 0.794, the Youden index was 0.332, the positive predictive value was 0.583 and the negative predictive value was 0.762. Based on the BNP threshold, a log-rank test was performed and it was determined that the cardiotoxicity-free survival rate of the group with higher levels of BNP was always lower compared with the group with lower levels of BNP. BNP elevation was associated with cardiotoxicity during the anthracycline chemotherapy. Detecting BNP after the final treatment of anthracycline chemotherapy may contribute to the early detection of cardiotoxicity.

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Section: Discussionsupporting

confidence: 87%

BNP as a marker for early prediction of anthracycline‑induced cardiotoxicity in patients with breast cancer

Zhao

Chen

et al. 2019

Oncol Lett

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“…Recent studies have demonstrated that strain changes precede EF changes in patients undergoing antineoplastic treatment. 14 , 16 , 18 - 21 However, no consensus has been reached regarding the specific cutoff point of that variable that should be used as a predictor of cardiotoxicity.…”

Section: Discussionmentioning

confidence: 99%

Global Longitudinal Strain Accuracy for Cardiotoxicity Prediction in a Cohort of Breast Cancer Patients During Anthracycline and/or Trastuzumab Treatment

Gripp

Oliveira

Feijó

et al. 2018

Arquivos Brasileiros De Cardiologia

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BackgroundThe high cardiotoxicity morbidity and mortality rates associated with the antineoplastic therapy for breast cancer could be reduced with the early use of cardioprotective drugs. However, the low sensitivity of left ventricular ejection fraction limits its use in that preventive strategy. New parameters, such as global longitudinal strain, are being used in the early detection of contractile function changes.ObjectivesTo assess the incidence of cardiotoxicity in patients treated for breast cancer, the independent factors associated with that event, and the ability of strain to identify it early.MethodsProspective observational study of consecutive outpatients diagnosed with breast cancer, with no previous antineoplastic treatment and no ventricular dysfunction, who underwent anthracycline and/or trastuzumab therapy. The patients were quarterly evaluated on a 6- to 12-month follow-up by an observer blind to therapy. Cox regression was used to evaluate the association of cardiotoxicity with clinical, therapeutic and echocardiographic variables. A ROC curve was built to identify the strain cutoff point on the third month that could predict the ejection fraction reduction on the sixth month. For all tests, the statistical significance level adopted was p ≤ 0.05.ResultsOf 49 women (mean age, 49.7 ± 12.2 years), cardiotoxicity was identified in 5 (10%) on the third (n = 2) and sixth (n = 3) months of follow-up. Strain was independently associated with the event (p = 0.004; HR = 2.77; 95%CI: 1.39-5.54), with a cutoff point for absolute value of -16.6 (AUC = 0.95; 95%CI: 0.87-1.0) or a cutoff point for percentage reduction of 14% (AUC = 0.97; 95%CI: 0.9-1.0).ConclusionThe 14% reduction in strain (absolute value of -16.6) allowed the early identification of patients who could develop anthracycline and/or trastuzumab-induced cardiotoxicity.

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“…It also inhibits HER2 shedding and metalloproteinase activity by decrease PTEN phosphorylation or AKT de‐phosphorylation to induce tumour cells death . Cardiotoxicity is a major reported side effect in trastuzumab‐treated patients and in some cases led to stop the antibody administration …”

Section: Anit‐her2 Mabs and Derivativesmentioning

confidence: 99%

“…[79] Cardiotoxicity is a major reported side effect in trastuzumab-treated patients and in some cases led to stop the antibody administration. [82,83] Pertuzumab (PERJETA)…”

Section: Trastuzumab (Herceptin)mentioning

confidence: 99%

Monoclonal antibody-based therapeutics, targeting the epidermal growth factor receptor family: from herceptin to Pan HER

Moradi‐Kalbolandi

Hosseinzade

Salehi

et al. 2018

Journal of Pharmacy and Pharmacology

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Objectives Monoclonal antibody-based of cancer therapy has been considered as one of the most successful therapeutic strategies for both haematologic malignancies and solid tumours in the last two decades. Epidermal growth factor receptor (EGFR) family signalling pathways play a key role in the regulation of cell proliferation, survival and differentiation. Hence, anti-EGFR family mAbs is one of the most promising approaches in cancer therapy. Key findings Here, recent advances in anti-EGFR mAb including approved or successfully tested in preclinical and clinical studies have been reviewed. Although we focus on monoclonal antibodies against the EGF receptor, but the mechanisms underlying the effects of EGFR-specific mAb in cancer therapy, to some extend the resistance to existing anti-EGFR therapies and some therapeutic strategies to overcome resistance such as combination of mAbs on different pathways are briefly discussed as well. Summary The EGFR family receptors, is considered as an attractive target for mAb development to inhibit their consecutive activities in tumour growth and resistance. However, due to resistance mechanisms, the combination therapies may become a good candidate for targeting EGFR family receptors.

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A Prospective Cohort Study on Cardiotoxicity of Adjuvant Trastuzumab Therapy in Breast Cancer Patients

Cited by 16 publications

References 37 publications

BNP as a marker for early prediction of anthracycline‑induced cardiotoxicity in patients with breast cancer

BNP as a marker for early prediction of anthracycline‑induced cardiotoxicity in patients with breast cancer

Global Longitudinal Strain Accuracy for Cardiotoxicity Prediction in a Cohort of Breast Cancer Patients During Anthracycline and/or Trastuzumab Treatment

Monoclonal antibody-based therapeutics, targeting the epidermal growth factor receptor family: from herceptin to Pan HER

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