Early Decline in Left Ventricular Ejection Fraction Can Predict Trastuzumab-Related Cardiotoxicity in Patients with Breast Cancer: A Study Using 13 Years of Registry Data

Kim, Eun Kyoung; Cho, Jinhyun; Kim, Jiyeon; Chang, Sung-A; Park, Sung‐Ji; Choi, Jin Oh; Lee, Sang‐Chol; Ahn, Jin Seok; Park, Seung Woo; Im, Young‐Hyuck; Jeon, Eun Seok; Park, Yeon Hee

doi:10.4143/crt.2018.262

Cited by 19 publications

(9 citation statements)

References 39 publications

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“…In the present study, the cumulative dose of anthracyclines, baseline LVEF and DC was revealed as independent risk factors of trastuzumab‐related cardiotoxicity. In agreement with previous data, 10,11 univariate and multivariate analyses in the present study showed that a high cumulative dose of anthracyclines was a risk factor for trastuzumab‐related cardiotoxicity. The cardiotoxicity of anthracyclines is an indisputable fact; however, due to the positive efficacy of anthracyclines in chemotherapy for breast cancer, 12 they are still widely used in clinical practice.…”

Section: Discussionsupporting

confidence: 93%

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Deceleration capacity of heart rate predicts trastuzumab‐related cardiotoxicity in patients with HER2‐positive breast cancer: A prospective observational study

2020

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Section: Discussionsupporting

confidence: 93%

“…Currently, there is accumulating evidence that low baseline LVEF is an objective predictor of trastuzumab treatment‐related cardiotoxicity, even when the baseline LVEF was within the normal range 10,15 . However, a uniform threshold has not been established due to the heterogeneity of the study populations.…”

Section: Discussionmentioning

confidence: 99%

Deceleration capacity of heart rate predicts trastuzumab‐related cardiotoxicity in patients with HER2‐positive breast cancer: A prospective observational study

2020

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“…A large analysis with 13 years of follow-up recently addressed this often overlooked issue. The authors focused on the implications of an early, asymptomatic LVEF drop on the subsequent development of significant or symptomatic cardiac toxicity [10]. In 337 out of 787 patients, a 5% or more LVEF loss from baseline occurring within the initial 3 months of trastuzumab treatment was predictive of the development of either a significant, asymptomatic reduction in LVEF or of congestive heart failure, which occurred in 5% and 2.3% of patients, respectively.…”

Section: Discussionmentioning

confidence: 99%

Treatment with Beta-Blockers and ACE-Inhibitors in Breast Cancer Patients Receiving Adjuvant Trastuzumab-Based Therapy and Developing Mild Cardiac Toxicity: A Prospective Study

Geuna

Lombardi

Martinello

et al. 2020

Cancers

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Background: Angiotensin Converting Enzyme inhibitors (ACEis) and beta-blockers (BB) are suggested to prevent and treat trastuzumab-related cardiac toxicity. We performed a prospective clinical trial in women experiencing mild cardiac toxicity (MCT) while on adjuvant treatment with trastuzumab. Methods: MCT was defined as an asymptomatic absolute decrease in LVEF of ≥ 10 percentage units to >50%. Treatment consisted of enalapril 2.5 mg bid and carvedilol 3.75 mg bid, which were up-titrated to 10 mg bid for the enalapril and 6.25 mg bid of carvedilol. In patients receiving study drug, the primary study end-point was LVEF recovery, which was defined as a post-trastuzumab LVEF returning to no less than −5 percentage points of the baseline value. Results: 103 patients were enrolled, 100 started trastuzumab, and 98 completed the planned treatment. Sixteen patients (16%) had MCT and received study drugs until trastuzumab completion. None of these patients achieved a post-trastuzumab LVEF recovery. Nevertheless, treated patients had significantly higher median LVEF recovery from nadir to post-trastuzumab LVEF in (8% points vs. 4% points, respectively, p = 0.004), resulting in no difference in post-treatment LVEF values compared to patients without MCT. Conclusion: Treatment of MCT with ACEis and BB allows faster LVEF recovery from nadir values and should be further studied in this setting.

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“…Other echocardiography parameters, such as myocardial performance index (MPI), which can identify subclinical cardiotoxicity in patients treated with 5-FU and anthracyclines, and mitral annular plane systolic excursion (MAPSE), may also be used [ 83 , 84 ]. LVEF <55% was associated with a significantly increased risk to develop HF, due to HER2 antagonists and anthracyclines [ 85 , 86 ].…”

Section: Diagnosis Methods Of Chemotherapy-induced Cardiotoxicity In Gi Cancersmentioning

confidence: 99%

Cardiotoxicity Associated with Chemotherapy Used in Gastrointestinal Tumours

et al. 2021

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Cardiotoxicity is a well-recognised side effect of cancer-related therapies with a great impact on outcomes and quality of life in the cancer survivor population. The pathogenesis of chemotherapy-induced cardiotoxicity in patients with gastrointestinal cancers involves various molecular mechanisms, and the combined use of various chemotherapies augments the risk of each drug used alone. In terms of cardiotoxicity diagnosis, novel biomarkers, such as troponins, brain natriuretic peptide (BNP), myeloperoxidases and miRNAs have been recently assessed. Echocardiography is a noninvasive imaging method of choice for the primary assessment of chemotherapy-treated patients to generally evaluate the cardiovascular impact of these drugs. Novel echocardiography techniques, like three-dimensional and stress echocardiography, will improve diagnosis efficacy. Cardiac magnetic resonance (CMR) can evaluate cardiac morphology, function and wall structure. Corroborated data have shown the importance of CMR in the early evaluation of patients with gastrointestinal cancers, treated with anticancer drugs, but further studies are required to improve risk stratification in these patients. In this article, we review some important aspects concerning the cardiotoxicity of antineoplastic drugs used in gastrointestinal cancers. We also discuss the mechanism of cardiotoxicity, the role of biomarkers and the imaging methods used in its detection.

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Early Decline in Left Ventricular Ejection Fraction Can Predict Trastuzumab-Related Cardiotoxicity in Patients with Breast Cancer: A Study Using 13 Years of Registry Data

Abstract: The overall incidence of TRCD was 7.4% in Asian breast cancer patients treated with adjuvant trastuzumab. A decline in LVEF ≥5% within the first 3 months of trastuzumab initiation was strongly associated with TRCD development in patients with breast cancer.

Cited by 19 publications

References 39 publications

Deceleration capacity of heart rate predicts trastuzumab‐related cardiotoxicity in patients with HER2‐positive breast cancer: A prospective observational study

Deceleration capacity of heart rate predicts trastuzumab‐related cardiotoxicity in patients with HER2‐positive breast cancer: A prospective observational study

Treatment with Beta-Blockers and ACE-Inhibitors in Breast Cancer Patients Receiving Adjuvant Trastuzumab-Based Therapy and Developing Mild Cardiac Toxicity: A Prospective Study

Cardiotoxicity Associated with Chemotherapy Used in Gastrointestinal Tumours

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