Trastuzumab-Induced Cardiotoxicity: Clinical and Prognostic Implications of Troponin I Evaluation

Cardinale, Daniela; Colombo, Alessandro; Torrisi, Rosalba; Sandri, Maria Teresa; Civelli, Maurizio; Salvatici, Michela; Lamantia, Giuseppina; Colombo, N.; Cortinovis, Sarah; Dessanai, Maria Antonietta; Nolè, Franco; Veglia, Fabrizio; Cipolla, Carlo M.

doi:10.1200/jco.2009.27.3615

Cited by 553 publications

(380 citation statements)

References 33 publications

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“…If LVEF drops exceeded 10%, the rate of reversibility number was reduced to 91% in the normal baseline LVEF group and to 71.4% in the low baseline LVEF group. These reversibility numbers are more favorable than those outlined in a prior study by Cardinale et al, which indicated that as many as 40% of patients with TIC might experience an irreversible decline in LVEF 8. However, irreversibility rates this high were noted even in the current study in patients who did not receive new or intensified cardiovascular medications.…”

Section: Discussioncontrasting

confidence: 64%

“…Adverse events typically associated with chemotherapy, such as alopecia, myelosuppression, and nausea and vomiting are not seen with trastuzumab. Cardiotoxicity, either leading to an asymptomatic decrease in left ventricular ejection fraction (LVEF) or heart failure (HF), remains the most important adverse effect 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16…”

Section: Introductionmentioning

confidence: 99%

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Trastuzumab in Female Breast Cancer Patients With Reduced Left Ventricular Ejection Fraction

Nowsheen

Aziz

Park

et al. 2018

JAHA

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BackgroundTrastuzumab is life‐extending therapy for breast cancer patients overexpressing the human epidermal growth factor receptor 2 (HER2+), but has known cardiotoxic risk. We sought to determine if trastuzumab can be administered to patients with reduced baseline cardiac function at no higher cardiotoxicity risk than in those with normal cardiac function at baseline.Methods and ResultsWe performed a retrospective study of women treated with trastuzumab for human epidermal growth factor receptor 2 breast cancer at Mayo Clinic Rochester between January 1, 2000 and August 31, 2015 with pre‐ and on‐therapy echocardiograms available for review. A left ventricular ejection fraction (LVEF) <53% was considered abnormal, and a ≥10% decline in LVEF as evidence of cardiotoxicity based on the criteria of the American Society of Echocardiography. A total of 428 women were identified; 408 had a normal cardiac function (LVEF 63.4±5%) and 20 had an impaired cardiac function (LVEF 45.4±7%) before trastuzumab. Seven women (35%) with reduced LVEF at baseline had a ≥10% reduction in LVEF, compared with 179 (43.9%) of those with normal LVEF before trastuzumab initiation (P=NS). Symptomatic heart failure developed more often in patients with reduced versus normal baseline LVEF (25% versus 4.2%, P<0.05). After adjusting for patient age and breast cancer disease stage, survival rates over 5 years from time of diagnosis were found to be lower for patients with reduced baseline LVEF compared with patients with normal baseline LVEF (P<0.001); the adjusted proportion of patients surviving at 5 years for those with low LVEF at baseline was 79% and for those with normal LVEF was 93%.ConclusionsWomen undergoing trastuzumab therapy for breast cancer with impaired baseline cardiac function experience no higher risk of LVEF decline, but more frequently develop symptomatic heart failure. While trastuzumab could be considered, these patients should be co‐managed by a cardiologist.

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Section: Discussioncontrasting

confidence: 64%

Section: Introductionmentioning

confidence: 99%

Trastuzumab in Female Breast Cancer Patients With Reduced Left Ventricular Ejection Fraction

Nowsheen

Aziz

Park

et al. 2018

JAHA

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“…Cardiac troponins are well‐established markers of myocardial injury and appear to correlate best with incident cardiac dysfunction following chemotherapy. Three studies have reported that elevated and increasing troponin I following chemotherapy, particularly if such increase persists at 1 month after treatment,84 is associated with subsequent cardiac dysfunction as well as with lower likelihood of cardiac recovery in patients receiving trastuzumab 85, 86, 87. During treatment, negative cardiac troponin has a high negative predictive value; however, minute elevations can be commonly detected in patients following chemotherapy and have low positive predictive value 88.…”

Section: Monitoring For Cardiac Dysfunction During Her2‐targeted Therapymentioning

confidence: 99%

Cardiotoxicity From Human Epidermal Growth Factor Receptor‐2 (HER2) Targeted Therapies

Florido

Smith

Cuomo

et al. 2017

JAHA

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“…Tn-I monitoring also served effectively as risk stratification in their studied population; patients treated with high-dose chemotherapy who developed an increased in Tn-I were the ones who benefited more from the initiation of an angiotensin-converting enzyme inhibitor treatment (enalapril), preventing LVEF decrease [47]. In addition, an increase in Tn-I was associated with a 17.6 times increased risk of cardiotoxicity, and emerged as the only independent predictor of lack of recovery in LVEF despite treatment with HF therapy, which consisted of enalapril and carvedilol upbeing titrated to maximally tolerated doses used in conventional HF [48]. However, these results still need to be confirmed [49][50][51].…”

Section: Circulating Biomarkersmentioning

confidence: 99%

Cardiac Imaging: Multimodality Advances and Surveillance Strategies in Detection of Cardiotoxicity

2017

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Contemporary cancer management has increased the overall number of cancer survivors, but cardiotoxicity remains a subject of concern, which is a major cause of noncancer mortality among survivors. Among the potential cardiovascular complications, left ventricular (LV) systolic dysfunction is a poor prognostic factor. The importance of its early detection is based on the principle that the likelihood of response to heart failure (HF) treatment is temporally related to the initiation of HF treatment. For these reasons, cardiac monitoring is commonly applied in general practice, based on serial measurements of LV ejection fraction (LVEF); transthoracic echocardiography (TTE) is generally used. However, the LVEF, as a diagnostic and predictive parameter, has significant limitations, which calls for more effective multimodality imaging strategies. This approach requires further study, but there is increasing available data in the literature, encouraging the combination of multimodality imaging parameters and techniques for early cancer therapeutic-related cardiac dysfunction (CTRCD) detection.

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Trastuzumab-Induced Cardiotoxicity: Clinical and Prognostic Implications of Troponin I Evaluation

Abstract: TNI+ identifies trastuzumab-treated patients who are at risk for cardiotoxicity and are unlikely to recover from cardiac dysfunction despite HF therapy.

Cited by 553 publications

References 33 publications

Trastuzumab in Female Breast Cancer Patients With Reduced Left Ventricular Ejection Fraction

Trastuzumab in Female Breast Cancer Patients With Reduced Left Ventricular Ejection Fraction

Cardiotoxicity From Human Epidermal Growth Factor Receptor‐2 (HER2) Targeted Therapies

Cardiac Imaging: Multimodality Advances and Surveillance Strategies in Detection of Cardiotoxicity

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