Adjuvant trastuzumab cardiotoxicity in patients over 60 years of age with early breast cancer: a multicenter cohort analysis

Tarantini, Luigi; Gori, Stefania; Faggiano, Pompilio; Pulignano, Giovanni; Simoncini, E.; Tuccia, Fausto; Ceccherini, Rita; Bovelli, Daniella; Lestuzzi, Chiara; Cioffi, Giovanni

doi:10.1093/annonc/mds127

Cited by 55 publications

(27 citation statements)

References 30 publications

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“…In a cohort of 490 Italian patients treated with trastuzumab in the adjuvant setting, the overall rate of trastuzumab-related CHF was 27%, but was 38% for patients older than 68 years. 26 In a recently published study, 3 the rates of CHF among patients with breast cancer were evaluated using data from the Cancer Research Network. Among 12,500 women, 554 trastuzumabtreated patients were identified.…”

Section: Discussionmentioning

confidence: 99%

“…23,26,[37][38][39] The updated analysis of NSABP-B31, 18 demonstrated that the use of antihypertensive medications (HR, 2.10; 95% CI, 1.07 to 4.13), baseline LVEF of 50% to 54% (HR, 6.72; 95% CI, 2.67 to 16.92), postdoxorubicin and cyclophosphamide LVEF of 50% to 54% (HR, 11.84; 95% CI, 3.90 to 35.99), and age (age 50 to 59 years: HR, 2.43; 95% CI, 1.14 to 5.19; age Ն 60 years: HR, 2.73, 95% CI, 1.13 to 6.60) were associated with increased risk. Our study is unique as we included the largest patient population of older patients with breast cancer treated with adjuvant chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…2,4,6,7,11,[17][18][19][20] Recent reports suggest that the incidence of trastuzumab-related cardiotoxicity is higher outside clinical trials, [21][22][23] and that older patients are at higher risk. [23][24][25][26] Of particular concern is cardiotoxicity in older women; data from National Surgical Adjuvant Breast and Bowel Project study B31/N9831 indicate that age is a risk factor for trastuzumab-related CHF.…”

Section: Introductionmentioning

confidence: 99%

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Trastuzumab-Related Cardiotoxicity Among Older Patients With Breast Cancer

Chávez-MacGregor

Zhang

Buchholz

et al. 2013

JCO

222

138

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Purpose The use of trastuzumab in the adjuvant setting improves outcomes but is associated with cardiotoxicity manifested as congestive heart failure (CHF). The rates and risk factors associated with trastuzumab-related CHF among older patients are unknown. Patients and Methods Breast cancer patients at least 66 years old with full Medicare coverage, diagnosed with stage I-III breast cancer between 2005 and 2009, and treated with chemotherapy were identified in the SEER-Medicare and in the Texas Cancer Registry–Medicare databases. The rates and risk factors associated with CHF were evaluated. Chemotherapy, trastuzumab use, comorbidities, and CHF were identified using International Classification of Diseases, version 9, and Healthcare Common Procedure Coding System codes. Analyses included descriptive statistics and Cox proportional hazards models. Results In total, 9,535 patients were included, of whom 2,203 (23.1%) received trastuzumab. Median age of the entire cohort was 71 years old. Among trastuzumab users, the rate of CHF was 29.4% compared with 18.9% in nontrastuzumab users (P < .001). Trastuzumab users were more likely to develop CHF than nontrastuzumab users (hazard ratio [HR], 1.95; 95% CI, 1.75 to 2.17). Among trastuzumab-treated patients, older age (age > 80 years; HR, 1.53; 95% CI, 1.16 to 2.10), coronary artery disease (HR, 1.82; 95% CI, 1.34 to 2.48), hypertension (HR, 1.24; 95% CI, 1.02 to 1.50), and weekly trastuzumab administration (HR, 1.33; 95% CI, 1.05 to 1.68) increased the risk of CHF. Conclusion In this large cohort of older breast cancer patients, the rates of trastuzumb-related CHF are higher than those reported in clinical trials. Among patients treated with trastuzumab, those with cardiac comorbidities and older age may be at higher risk. Further studies need to confirm the role that the frequency of administration plays in the development of trastuzumab-related CHF.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Trastuzumab-Related Cardiotoxicity Among Older Patients With Breast Cancer

Chávez-MacGregor

Zhang

Buchholz

et al. 2013

JCO

222

138

View full text Add to dashboard Cite

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“…We also collected information on adjuvant treatment including the chemotherapy regimen. The patients were divided into two groups according to age because an age exceeding 60 years is an important risk factor for trastuzumab-associated cardiac toxicity [13,17,18]. The institutional review board of Gangnam Severance Hospital, Yonsei University, approved this retrospective study in accordance with good clinical practice guidelines and the Declaration of Helsinki.…”

Section: Methodsmentioning

confidence: 99%

“…However, it could have adverse cardiac effects in some patients, and congestive heart failure due to cardiac dysfunction could occur [8,9]. Occasionally, this adverse effect is lethal; hence, the incidence of cardiac toxicity and risk factors has been evaluated in previous studies, which were primarily performed in Western countries [10,11,12,13]. …”

Section: Introductionmentioning

confidence: 99%

Assessment of Adjuvant Trastuzumab-Associated Cardiac Toxicity in Korean Patients with Breast Cancer: A Single-Center Analysis

et al. 2013

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Background: We performed this analysis to investigate the clinical presentation of trastuzumab-associated cardiac toxicity in Korean women. Method: 124 patients treated in a single institute from January 2006 to November 2011 with adjuvant trastuzumab therapy following primary surgery were identified from a database. We evaluated the cumulative incidence of cardiac toxicity, associated risk factors, and changes in cardiac function during trastuzumab treatment. Results: The median age of patients was 50 years (range 27-73). After 12 months of follow-up, the cumulative incidence of cardiac toxicity was 12.1% (grade I: 8.1%, grade II: 0.8%, grade III: 3.2%). In total, 4% of patients discontinued treatment due to cardiac dysfunction. The left ventricular ejection fraction (LVEF) recovered in all patients who discontinued or delayed treatment due to cardiac dysfunction following treatment discontinuation. The degree of the decrease in LVEF was large at 6 months after the initiation of treatment. A lower LVEF at baseline (<65%) was associated with cardiac toxicity. Conclusions: The low incidence of cardiac toxicity and the reversibility of cardiac dysfunction may validate the safety of trastuzumab treatment in Korean women with an acceptable baseline LVEF.

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Evaluation of 1-Year vs Shorter Durations of Adjuvant Trastuzumab Among Patients With Early Breast Cancer

et al. 2020

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Key Points Question Is shorter duration adjuvant trastuzumab noninferior to its 1-year use for patients with early breast cancer? Findings In this meta-analysis of individual patient data from 5 randomized clinical trials (with 11 376 participants) and trial-level data from 6 randomized clinical trials (with 11 603 participants), shorter duration of adjuvant trastuzumab was noninferior to 1 year of treatment in terms of disease-free survival and was associated with lower rates of cardiac toxic effects. Meaning The findings of this study suggest that a shorter duration of adjuvant trastuzumab may be the preferred option for patients with low-risk disease or a predisposition to cardiac toxic effects.

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Adjuvant trastuzumab cardiotoxicity in patients over 60 years of age with early breast cancer: a multicenter cohort analysis

Cited by 55 publications

References 30 publications

Trastuzumab-Related Cardiotoxicity Among Older Patients With Breast Cancer

Trastuzumab-Related Cardiotoxicity Among Older Patients With Breast Cancer

Assessment of Adjuvant Trastuzumab-Associated Cardiac Toxicity in Korean Patients with Breast Cancer: A Single-Center Analysis

Evaluation of 1-Year vs Shorter Durations of Adjuvant Trastuzumab Among Patients With Early Breast Cancer

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