Cardiac Monitoring and Heart Failure in Advanced Breast Cancer Patients Treated With Trastuzumab in Ontario, Canada

Abstract

BackgroundTrastuzumab has improved patient outcomes in HER2 + breast cancer (BC) but carries a risk of cardiotoxicity. Routine cardiac imaging is recommended for advanced breast cancer (aBC) patients during trastuzumab treatment despite a lack of evidence that this improves patient outcomes. This study was conducted to understand predictive factors for cardiac events and determine the impact of cardiovascular monitoring in aBC.MethodsThis retrospective population-based cohort study included aBC patients treated with trastuzumab (all lines), in Ontario, Canada from 2007 to 2017. The overall cohort was divided into two groups; those who developed a cardiac event (CE) vs. those who did not. Patients with pre-existing heart disease were excluded. Logistic regression was performed to identify patient characteristics associated with an increased risk of CE.ResultsOf 2,284 patients with HER2 + aBC treated with trastuzumab, 167 (7.3%) developed a CE. Median age at first dose of trastuzumab was 57 (IQR 49–66); 61 (IQR 51–70) for patients with a CE. Median number of cycles was 16 (IQR 7–32); 21 (IQR 8–45) for patients with a CE (p < 0.01). Twelve (0.5%) patients died of cardiac causes; all had a prior CE. Increased risk of CEs was associated with age > 60 (OR 5.21, 95% CI 1.83–14.84, p = 0.05) and higher number cycles of trastuzumab (OR 1.01; 95% CI 1–101, p = 0.028).ConclusionThis is the first population-based study to report on CEs and cardiac monitoring in HER2 + aBC patients during trastuzumab-based therapy. Older age and longer treatment with trastuzumab were associated with an increased risk of a CE.

Assessing Adherence to Cardiac Monitoring Guidelines in Trastuzumab-Treated Breast Cancer Patients: Insights From a Tertiary Hospital

“…The advent of anti-HER2 targeted therapy has marked a pivotal shift in the management of HER2-positive breast cancer, significantly enhancing patient outcomes. Nonetheless, these therapeutic strides come with challenges, particularly as treatments based on trastuzumab have been associated with increased cardiac toxicity risks [8,9,13]. This discussion aims to contextualize our research findings, focusing on adherence to monitoring guidelines, the emergence of cardiotoxicity, and the pressing demand for precise risk assessment tools.…”

“…Trastuzumab is recommended as an adjunctive therapy in conjunction with chemotherapy for patients with breast cancer who exhibit HER2 overexpression. This combined approach underscores the importance of trastuzumab in the comprehensive management of HER2-positive breast cancer cases [8][9][10]. Indeed, it should be noted that HER2 is expressed not only in cancer cells but also in the myocardium, specifically within the myocytes of the heart.…”

“…Despite the elevated risk of cardiotoxicity associated with trastuzumab, it is important to recognize that optimal monitoring protocols for this condition have not been definitively established through prospective cohort studies. Consequently, cardiotoxicity monitoring is primarily based on expert consensus and regulatory agencies, such as the Food and Drug Administration (FDA) [8][9][10][11][12]. The FDA, for example, recommends a monitoring schedule that involves cardiac function evaluations every three months during the first year of treatment and then extends to every six months during the second year.…”

“…The FDA, for example, recommends a monitoring schedule that involves cardiac function evaluations every three months during the first year of treatment and then extends to every six months during the second year. This approach aims to detect any early signs of cardiotoxicity and guide clinical decisions accordingly [9]. According to the guidance provided by the National Comprehensive Cancer Network (NCCN), it is recommended to implement structured cardiac monitoring at designated intervals throughout the duration of trastuzumab therapy.…”

Assessment of Cardiotoxicity incidence in patients receiving HER-2-targeted therapies for breast cancer in Saudi Arabia

“…Several research have failed to identify the risk factors that have a signi cant in uence in the development of heart failure. A limited number of studies found that age and the number of cycles signi cantly increase the risk of heart failure [23,24]. Moreover, the administration of doxorubicin and cyclophosphamide concurrently could raise the risk of cardiotoxicity by up to 27% [25].…”