Early Trastuzumab Interruption and Recurrence-Free Survival in <i>ERBB2</i>-Positive Breast Cancer

Copeland‐Halperin, Robert S.; Al‐Sadawi, Mohammed; Patil, Sujata; Liu, Jennifer E.; Steingart, Richard M.; Dang, Chau T.; Yu, Anthony F.

doi:10.1001/jamaoncol.2020.4749

Cited by 23 publications

(16 citation statements)

References 6 publications

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“…Cancer therapy-related cardiac dysfunction diagnosis is the most common indication for chemotherapy interruption (up to 38.1% in our cohort) (26). For instance, the patients with HER2-breast cancer with early trastuzumab interruption had higher rates of cancer recurrence and death than the patients receiving uninterrupted treatment (8). This fact could explain that trastuzumab was identified as a predictor of mortality in our cohort, emphasizing the negative impact of chemotherapy withdrawal on the prognosis.…”

Section: Discussionmentioning

confidence: 62%

“…heart failure (HF), non-CV causes of death, especially cancer, were more prevalent than HF progression or sudden death (7). Additionally, the cardiotoxic effects are a critical treatmentlimiting adverse effect of some chemotherapies and targeted therapies, affecting the prognosis (8). It is essential to implement the multidisciplinary cardio-oncology units to diagnose and treat LVSD early (3).…”

Section: Introductionmentioning

confidence: 99%

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Clinical Profile and Prognosis of a Real-World Cohort of Patients With Moderate or Severe Cancer Therapy-Induced Cardiac Dysfunction

Esteban‐Fernández

Estupiñan

Gavira-Gómez

et al. 2021

Front. Cardiovasc. Med.

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Introduction and Objectives: Cancer therapy-related cardiac dysfunction (CTRCD) is a common cause of cancer treatment withdrawal, related to the poor outcomes. The cardiac-specific treatment could recover the left ventricular ejection fraction (LVEF). We analyzed the clinical profile and prognosis of patients with CTRCD in a real-world scenario.Methods: A retrospective study that include all the cancer patients diagnosed with CTRCD, defined as LVEF < 50%. We analyzed the cardiac and oncologic treatments, the predictors of mortality and LVEF recovery, hospital admission, and the causes of mortality (cardiovascular (CV), non-CV, and cancer-related).Results: We included 113 patients (82.3% women, age 49.2 ± 12.1 years). Breast cancer (72.6%) and anthracyclines (72.6%) were the most frequent cancer and treatment. Meantime to CTRCD was 8 months, with mean LVEF of 39.4 ± 9.2%. At diagnosis, 27.4% of the patients were asymptomatic. Cardiac-specific treatment was started in 66.4% of patients, with LVEF recovery-rate of 54.8%. Higher LVEF at the time of CTRCD, shorter time from cancer treatment to diagnosis of CTRCD, and younger age were the predictors of LVEF recovery. The hospitalization rate was 20.4% (8.8% linked to heart failure). Treatment with trastuzumab and lower LVEF at diagnosis of CTRCD were the predictors of mortality. Thirty point nine percent of patients died during the 26 months follow-up. The non-CV causes and cancer-related were more frequent than CV ones.Conclusions: Cardiac-specific treatment achieves LVEF recovery in more than half of the patients. LVEF at the diagnosis of CTRCD, age, and time from the cancer treatment initiation to CTRCD were the predictors of LVEF recovery. The CV-related deaths were less frequent than the non-CV ones. Trastuzumab treatment and LVEF at the time of CTRCD were the predictors of mortality.

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Section: Discussionmentioning

confidence: 62%

Section: Introductionmentioning

confidence: 99%

Clinical Profile and Prognosis of a Real-World Cohort of Patients With Moderate or Severe Cancer Therapy-Induced Cardiac Dysfunction

Esteban‐Fernández

Estupiñan

Gavira-Gómez

et al. 2021

Front. Cardiovasc. Med.

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“…In a recent populationbased study (5500 women) in Ontario, patients who did not complete the recommended course of adjuvant trastuzumab, including those with cardiotoxicity, had a statistically higher risk of breast cancer relapse and death [59]. A recent study from Memorial Sloan Kettering Cancer Center (1396 women) corroborated an increased risk of breast cancer recurrence and death with interruption of trastuzumab therapy, 24% (interrupted) vs. 13% (continuous), highlighting the importance of continued investigation of monitoring, prevention, and management of cardiac dysfunction to limit treatment interruption or cessation [60]. Several prospective studies, namely, PRADA, MANTICORE, Guglin et al, Boekhout et al, suggest ACE inhibitors and/or beta-blockers for primary prevention in HER2-positive breast cancer patients with/without combination anthracycline therapy (Table 3) [61].…”

Section: Cardiovascular Monitoring Strategies For Her2-targeted Therapymentioning

confidence: 99%

Cardiovascular Toxicity of Novel HER2-Targeted Therapies in the Treatment of Breast Cancer

et al. 2021

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Purpose of Review HER2-targeted therapies have led to improved clinical outcomes in early and advanced breast cancer (BC). We review the long-term cardiotoxicity of HER2-targeted therapy in early and advanced BC, our current knowledge of cardiotoxicity of novel HER2-targeted therapies, and propose a cardiac monitoring (CM) strategy for this population. Recent Findings Long-term data from studies with HER2-targeted therapy in the adjuvant setting have failed to demonstrate an increase in cardiotoxicity over time, and rates of cardiotoxicity seen with novel HER2 agents remain low. Despite over a decade of experience with HER2-targeted therapy, CM in clinical practice is inconsistent in patients with early BC and almost non-existent in advanced BC. Summary Long-term follow-up of clinical trials with HER2-targeted agents in early and advanced BC has failed to demonstrate increased rates of cardiotoxicity over time, attesting to the long-term safety of this class of drugs for the majority of patients, although the long-term cardiac safety of newer HER2 agents in the non-clinical trial setting is largely unknown. We propose CM incorporating clinical history, cardiac imaging, and biomarkers.

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“…Currently published statements from cardiac imaging societies delineate the timing and prioritization of cardiac imaging studies in the general patient population during the COVID-19 pandemic, including recommendations for laboratory safety and PPE use (18,(21)(22)(23)(24)(25)(26). However, the urgency and timing of imaging studies specifically in cardio-oncology patients must be carefully considered, especially because cancer treatment must be continued in many patients, as holding these treatments may decrease survival (27).…”

Section: Multimodality Cardiac Imaging In Oncology Patients During the Covid-19 Pandemicmentioning

confidence: 99%

Cardiovascular Care of the Oncology Patient During COVID-19: An Expert Consensus Document From the ACC Cardio-Oncology and Imaging Councils

Baldassarre

Yang

Cheng

et al. 2020

JNCI: Journal of the National Cancer Institute

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In response to the coronavirus disease 2019 (COVID-19) pandemic, The Cardio-Oncology and Imaging Councils of the American College of Cardiology offers recommendations to clinicians regarding the cardiovascular care of cardio-oncology patients in this expert consensus statement. Cardio-oncology patients–individuals with an active or prior cancer history, and with or at risk of cardiovascular disease–are a rapidly growing population, who are both at increased risk of infection by COVID-19 and experiencing severe and/or lethal complications. Recommendations for optimizing screening and monitoring visits to detect cardiac dysfunction are discussed. In addition, judicious use of multimodality imaging and biomarkers are proposed to identify myocardial, valvular, vascular, pericardial involvement in cancer patients. The difficulties of diagnosing the etiology of cardiovascular complications in patients with cancer and COVID-19 are outlined, along with weighing the advantages against risks of exposure, with the modification of existing cardiovascular treatments and cardiotoxicity surveillance in patients with cancer during the COVID-19 pandemic.

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Early Trastuzumab Interruption and Recurrence-Free Survival in ERBB2-Positive Breast Cancer

Cited by 23 publications

References 6 publications

Clinical Profile and Prognosis of a Real-World Cohort of Patients With Moderate or Severe Cancer Therapy-Induced Cardiac Dysfunction

Clinical Profile and Prognosis of a Real-World Cohort of Patients With Moderate or Severe Cancer Therapy-Induced Cardiac Dysfunction

Cardiovascular Toxicity of Novel HER2-Targeted Therapies in the Treatment of Breast Cancer

Cardiovascular Care of the Oncology Patient During COVID-19: An Expert Consensus Document From the ACC Cardio-Oncology and Imaging Councils

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