Risk of cardiac dysfunction with trastuzumab in breast cancer patients: A meta-analysis

Chen, Tao; Xu, Tao; Yang, Li; Liang, Chun; Chen, Juxiang; Lu, Yao; Wu, Zonggui; Wu, Shenhong

doi:10.1016/j.ctrv.2010.09.001

Cited by 104 publications

(76 citation statements)

References 36 publications

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“…In the ToGA trial, 5% of the patients in the trastuzumab arm experienced a ≥10% drop in left ventricular ejection function (LVEF) to an absolute value <50%. This was consistent with the incidence rate of LVEF decrease in breast cancer patients treated with trastuzumab, which was 7.5% in a meta-analysis published in 2011 (30).…”

Section: Current Therapeutic Landscape For Advanced Gastroesophageal supporting

confidence: 74%

Current therapeutic landscape for advanced gastroesophageal cancers

et al. 2018

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Treatment of advanced gastroesophageal cancers remains challenging for clinicians, patients, and caregivers alike. Despite considerable research, the therapeutic armamentarium is restricted and hardly personalized. In the first-line setting, trastuzumab with a fluoropyrimidine and platinum agent is the standard-of-care in patients with HER2-positive tumor. For the others, a platinum-based doublet (preferably with oxaliplatin) is recommended. Three-drug cytotoxic regimens should be reserved for exceptional cases where patients have good performance status. Triple combinations produce higher toxicity and provide marginal advantage. In the second line setting, the combination of paclitaxel and ramucirumab is preferred over all others. Currently, nothing is approved in the 3 rd or later line. Nivolumab has resulted in an improved benefit in an Asian trial. Early trials of TAS-102, STAT3 inhibitors, anti-claudin 18.2 and other immune checkpoint inhibitors (alone or in combination) are ongoing. However, development of reproducible biomarkers for patient enrichment is critical for future progress.

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Section: Current Therapeutic Landscape For Advanced Gastroesophageal supporting

confidence: 74%

Current therapeutic landscape for advanced gastroesophageal cancers

et al. 2018

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“…Consonant with previous meta-analysis [11], the incidence of CHF was still low among patients receiving trastuzumab, but the risk of CHF was increased by approximately three to four times compared with controls. Unlike previous studies limited to shorter-term follow-up that did not simultaneously quantify heterogeneity according to trastuzumab dose and duration of use, our study has updated currently available data of trastuzumab-associated CHF in EBC patients with longer-term follow-up, for example 5 years [18,20], 7 years [22], and 8 years [24].…”

Section: Discussionmentioning

confidence: 99%

“…Three previous meta-analyses [9][10][11] have reported the cardiac risk associated with trastuzumab in several trials of trastuzumab in breast cancer. However, those studies were limited to shorter-duration trastuzumab use, and the CHF profile of 2-year trastuzumab was not reported.…”

Section: Introductionmentioning

confidence: 99%

Risk of Congestive Heart Failure in Early Breast Cancer Patients Undergoing Adjuvant Treatment With Trastuzumab: A Meta-Analysis

et al. 2016

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Background. The use of trastuzumab has proven to be a successful strategy in patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer; however, it is associated with an increased risk of cardiac dysfunction. We performed an up-to-date, comprehensive meta-analysis to clarify the risk of congestive heart failure (CHF) in patients with early breast cancer receiving different durations of adjuvant trastuzumab with the longest-term follow-up. Methods. Eligible studies included randomized control trials of HER2-positive early breast cancer patients with or without trastuzumab in adjuvant chemotherapy. Adequate reporting of CHF data were required for inclusion. Statistical analyses were conducted to calculate the overall incidence, relative risk (RR), and 95% confidence interval (CI) by use of a fixed-effects model. Results. Six randomized control trials including 18,111 patients were identified.The overall incidence of high-grade CHF

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“…The meta-analysis by Chen et al 22 of 11,882 patients in ten rcts found rates of left ventricular ejection fraction decline and congestive heart failure to be 7.5% and 1.9% respectively among patients receiving trastuzumab. Those rates were significantly higher than the rates in patients receiving no trastuzumab (rr: 2.13; p = 0.003; and rr: 4.19; p < 0.00001).…”

Section: Chen Et Al 2011mentioning

confidence: 99%

Systemic Targeted Therapy for her2-Positive Early Female Breast Cancer: A Systematic Review of the Evidence for the 2014 Cancer Care Ontario Systemic Therapy Guideline

Mates

Fletcher

et al. 2015

Current Oncology

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BackgroundThis systematic review addresses the question “What is the optimal targeted therapy for female patients with early-stage human epidermal growth factor receptor 2 (her2)–positive breast cancer?”MethodsThe medline and embase databases were searched for the period January 2008 to May 2014. The Standards and Guidelines Evidence directory of cancer guidelines and the Web sites of major guideline organizations were also searched.ResultsSixty publications relevant to the targeted therapy portion of the systematic review were identified. In four major trials (hera, National Surgical Adjuvant Breast and Bowel Project B-31, North Central Cancer Treatment Group N9831, and Breast Cancer International Research Group 006), adjuvant trastuzumab for 1 year was superior in disease-free survival (dfs) and overall survival (os) to no trastuzumab; trastuzumab showed no benefit in one trial (pacs 04). A shorter duration of trastuzumab (less than 1 year compared with 1 year) was evaluated, with mixed results for dfs: one trial showed superiority (finher), one trial could not demonstrate noninferiority (phare), another trial showed equivalent results (E 2198), and one trial is still ongoing (persephone). Longer trastuzumab duration (hera: 2 years vs. 1 year) showed no improvement in dfs or os and a higher rate of cardiac events. Newer her2-targeted agents (lapatinib, pertuzumab, T-DM1, neratinib) have been or are still being evaluated in both adjuvant and neoadjuvant trials, either by direct comparison with trastuzumab alone or combined with trastuzumab. In the neoadjuvant setting (neoaltto, GeparQuinto, Neosphere), trastuzumab alone or in combination with another anti-her2 agent (lapatinib, pertuzumab) was compared with either lapatinib or pertuzumab alone and showed superior or equivalent rates of pathologic complete response. In the adjuvant setting, lapatinib alone or in combination with trastuzumab, compared with trastuzumab alone (altto) or with placebo (teach), was not superior in dfs. The results of the completed aphinity trial, evaluating the role of dual her2 blockade with trastuzumab and pertuzumab, are highly anticipated. Ongoing trials are evaluating trastuzumab as a single agent without adjuvant chemotherapy (respect) and in patients with low her2 expression (National Surgical Adjuvant Breast and Bowel Project B-47).ConclusionsTaking into consideration disease characteristics and patient preference, 1 year of trastuzumab should be offered to all patients with her2-positive breast cancer who are receiving adjuvant chemotherapy. Cardiac function should be regularly assessed in this patient population.

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Risk of cardiac dysfunction with trastuzumab in breast cancer patients: A meta-analysis

Cited by 104 publications

References 36 publications

Current therapeutic landscape for advanced gastroesophageal cancers

Current therapeutic landscape for advanced gastroesophageal cancers

Risk of Congestive Heart Failure in Early Breast Cancer Patients Undergoing Adjuvant Treatment With Trastuzumab: A Meta-Analysis

Systemic Targeted Therapy for her2-Positive Early Female Breast Cancer: A Systematic Review of the Evidence for the 2014 Cancer Care Ontario Systemic Therapy Guideline

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