Trastuzumab Adjuvant Chemotherapy and Cardiotoxicity in Real-World Women With Breast Cancer

Tarantini, Luigi; Cioffi, Giovanni; Gori, Stefania; Tuccia, Fausto; Boccardi, L; Bovelli, Daniella; Lestuzzi, Chiara; Maurea, Nicola; Oliva, Stefano; Russo, Giulia; Faggiano, Pompilio

doi:10.1016/j.cardfail.2011.10.015

Cited by 94 publications

(72 citation statements)

References 35 publications

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“…Although the risk of heart failure during therapy is low, ranging from 1% to 4%, asymptomatic LVEF declines are more common, reported in 7%-19% of patients in clinical trials [2,5,6]. In clinical practice, rates of adverse cardiac events are considerably higher, particularly among older patients who often have underlying cardiovascular disease or risk factors [7][8][9][10].These patients are not well represented in clinical trials.…”

Section: Introductionmentioning

confidence: 99%

Continuous Trastuzumab Therapy in Breast Cancer Patients With Asymptomatic Left Ventricular Dysfunction

Yadav

Eaton

et al. 2015

The Oncologist

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Background. Adjuvant trastuzumab is a highly effective targeted treatment that improves survival for patients with HER2-positive breast cancer. However, trastuzumab interruption is recommended for patients who develop treatmentinduced cardiotoxicity (i.e., decline in left ventricular ejection fraction [LVEF], with or without symptoms) and can lead to an incomplete course of treatment.We studied the cardiac safety of continuous trastuzumab therapy among patients with asymptomatic declines in LVEF. Methods. We retrospectively evaluated patients with HER2-positive breast cancer treated with adjuvant trastuzumab at our institution between 2005 and 2010. Treatment-induced cardiotoxicity was defined by an absolute decrease in LVEF of $10% to below 55% or an absolute decrease of $16%. Logistic regression was used to determine the association

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Section: Introductionmentioning

confidence: 99%

Continuous Trastuzumab Therapy in Breast Cancer Patients With Asymptomatic Left Ventricular Dysfunction

Yadav

Eaton

et al. 2015

The Oncologist

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“…Previous experimental [7] and observational investigations [8,9,19,20] generally recorded rates of asymptomatic and symptomatic CHF, although using different clinical and echocardiographical parameters to define it. However, in the current study, we considered only cardiac diseases leading to hospital admission, which therefore were of a high degree of severity.…”

Section: Discussionmentioning

confidence: 99%

“…Potential predictors of trastuzumab-related cardiotoxicity were investigated in several studies [8,9,19,20]. These predictors include traditional cardiovascular risk factors, such as older age, obesity, smoking, dyslipidemia, hypertension, diabetes, history of cardiac disease, and selected clinical and serological parameters, such as renal function blood test and hemoglobin.…”

Section: Discussionmentioning

confidence: 99%

Trastuzumab-Related Cardiotoxicity in Early Breast Cancer: A Cohort Study

et al. 2013

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Background. Concerns have been raised about the cardiac safety profile of trastuzumab for the adjuvant treatment of early stage breast cancer in clinical practice. We assessed trastuzumab-related cardiotoxicity and its predictors in a large cohort of Italian women. Methods. Through a record linkage between four regional health care databases, we identified the rate of severe cardiac adverse events among women treated with trastuzumab for early breast cancer in Lombardy. The cumulative risk of cardiotoxicity was estimated using the Kaplan-Meier method, and independent predictors were assessed using the Cox model. Results. Of 2,046 trastuzumab users, 53 (2.6%) experienced at least one hospitalization for a cardiac event, and there were two cardiac deaths. The cumulative risk of cardiotoxicity increased up to 2 years after starting treatment, reaching a plateau at 2.8%. The risk was low (0.2%) among young women, whereas the incidence was approximately 10% in women aged Ն70 years, irrespective of cardiovascular risk factors. Age and history of cardiac disease were strong predictors of cardiotoxicity, with a hazard ratio of 11.3 (95% confidence interval [CI]: 3.5-36.6) for women aged Ն70 years as compared with those Ͻ50 years of age. Hazard ratio was 4.4 (95% CI: 2.1-9.5) for women with a history of cardiac disease compared with those without a history of cardiac disease. Conclusions. Cardiotoxicity of trastuzumab varies considerably across subgroups of patients. The long-term safety profile was less favorable than in the largest clinical trial. Strategies to reduce cardiotoxicity in high-risk women should be investigated. The Oncologist 2013;18:795-801 Implications for Practice: Concerns have been raised about the safety profile of trastuzumab for older, less healthy, unselected populationsoutsideofclinicaltrials.Cliniciansneedinformationontheincidenceofcardiotoxicityoftrastuzumab-basedadjuvantregimens in patients with HER-2 positive early invasive breast cancer in clinical practice, according to patient characteristics. This large cohort suggests that the incidence of short-term severe cardiotoxicity (not only congestive heart failure) in clinical practice is higher than that recorded in clinical trials that tested the same regimen. Age and history of cardiac disease are strong predictors of cardiotoxicity. The risk/ benefit profile of trastuzumab should be quantitatively assessed, and strategies to reduce cardiotoxicity-especially in older women (Ն70 years) and women Ͼ50 years of age with several cardiovascular risk factors-should be developed.

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“…Najnowsze dane wskazują na wzrastający odsetek powikłań sercowo-naczyniowych po przebytym leczeniu uzupełnia-jącym u chorych na raka piersi (największe ryzyko dotyczy pacjentów, którzy otrzymywali antracykliny i trastuzumab) [4][5][6]. Polskie obserwacje potwierdzają, że przebyte chemioterapie neoadiuwantowa i adiuwantowa z wykorzystaniem antracyklin oraz wywiad zdarzeń wieńcowych są najistotniejszymi czynnikami ryzyka wystąpienia skurczowej niewydolności lewokomorowej u kobiet z przerzutowym rakiem piersi [7].…”

Section: Leczenie Doksorubicyną Wobec Codziennych Problemów Klinicznychunclassified

Liposomal doxorubicin in patients with breast cancer and concomitant cardiovascular diseases — interdisciplinary expert opinion

Szmit¹,

Filipiak‬²,

Litwiniuk³

et al. 2016

Kardiol Pol

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Trastuzumab Adjuvant Chemotherapy and Cardiotoxicity in Real-World Women With Breast Cancer

Cited by 94 publications

References 35 publications

Continuous Trastuzumab Therapy in Breast Cancer Patients With Asymptomatic Left Ventricular Dysfunction

Continuous Trastuzumab Therapy in Breast Cancer Patients With Asymptomatic Left Ventricular Dysfunction

Trastuzumab-Related Cardiotoxicity in Early Breast Cancer: A Cohort Study

Liposomal doxorubicin in patients with breast cancer and concomitant cardiovascular diseases — interdisciplinary expert opinion

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