Cardiotoxicity of trastuzumab emtansine (T-DM1): a single-center experience

Abstract

Objective New anti-cancer drugs promise to increased survival benefits and reduce adverse events. Trastuzumab emtansine (T-DM1) is a novel anti-human epidermal growth factor receptor 2 agent that has shown minimal cardiotoxicity in clinical trials. However, data on real-life outcomes are required. Methods A retrospective review of our center’s medical records was performed, including female patients aged ≥18 years with a diagnosis of metastatic breast cancer who were treated with T-DM1. Descriptive statistics were used to investigate clinical features that could increase the risk of cardiotoxicity. Cardiotoxicity was determined by comparing pre and post-T-DM1 echocardiogram results and was defined as a decrease in the left ventricular ejection fraction (LVEF) >10% to below 55%. Results Data from 41 female patients with a mean age of 52 ± 11.5 years were evaluated. A significant LVEF decrease (from 59% to 33%) was observed in one patient during T-DM1 treatment. Further investigation showed that this decrease was due to underlying coronary artery disease, and LVEF recovered to the baseline value after coronary revascularization. Conclusion T-DM1 seems to be safe in terms of cardiotoxicity. Real-life data with a larger sample size are still needed to confirm the cardiac safety of T-DM1.

Trastuzumab-Emtansine and Osimertinib Combination Therapy to Target HER2 Bypass Track Resistance in EGFR Mutation-Positive NSCLC

“…The latter is a known side effect of both T-DM1 and osimertinib. [6][7][8] Second, in this study, we treated five patients with osimertinib monotherapy after progression on a firstor second-generation EGFR TKI before the addition of T-DM1. These patients had HER2 overexpression in their progression biopsy, but were T790M double negative (biopsy and plasma).…”

Strategies for Mitigating Antibody-Drug Conjugate Related Adverse Events for Precision Therapy

“…The risk of trastuzumab emtansine-associated cardiotoxicity is relatively low 48–50 ; yet, the FDA lists reductions in left ventricular ejection fraction as a boxed warning for the trastuzumab-containing ADC 9 . Compared with trastuzumab emtansine, trastuzumab deruxtecan has been associated with higher rates of left ventricular dysfunction or decreased ejection fraction in multiple trials, although the incidence remains relatively low 18,26 .…”