Prospective evaluation of the cardiac safety of HER2-targeted therapies in patients with HER2-positive breast cancer and compromised heart function: the SAFE-HEaRt study Journal Article


Authors: Lynce, F.; Barac, A.; Geng, X.; Dang, C.; Yu, A. F.; Smith, K. L.; Gallagher, C.; Pohlmann, P. R.; Nunes, R.; Herbolsheimer, P.; Warren, R.; Srichai, M. B.; Hofmeyer, M.; Cunningham, A.; Timothee, P.; Asch, F. M.; Shajahan-Haq, A.; Tan, M. T.; Isaacs, C.; Swain, S. M.
Article Title: Prospective evaluation of the cardiac safety of HER2-targeted therapies in patients with HER2-positive breast cancer and compromised heart function: the SAFE-HEaRt study
Abstract: PurposeHER2-targeted therapies have substantially improved the outcome of patients with breast cancer, however, they can be associated with cardiac toxicity. Guidelines recommend holding HER2-targeted therapies until resolution of cardiac dysfunction. SAFE-HEaRt is the first trial that prospectively tests whether these therapies can be safely administered without interruptions in patients with cardiac dysfunction.MethodsPatients with stage I-IV HER2-positive breast cancer candidates for trastuzumab, pertuzumab or ado-trastuzumab emtansine (TDM-1), with left ventricular ejection fraction (LVEF) 40-49% and no symptoms of heart failure (HF) were enrolled. All patients underwent cardiology visits, serial echocardiograms and received beta blockers and ACE inhibitors unless contraindicated. The primary endpoint was completion of the planned HER2-targeted therapies without developing either a cardiac event (CE) defined as HF, myocardial infarction, arrhythmia or cardiac death or significant asymptomatic worsening of LVEF. Thestudy was considered successful if planned oncology therapy completion rate was at least 30%.ResultsOf 31 enrolled patients, 30 were evaluable. Fifteen patients were treated with trastuzumab, 14 with trastuzumab and pertuzumab, and 2 with TDM-1. Mean LVEF was 45% at baseline and 46% at the end of treatment. Twenty-seven patients (90%) completed the planned HER2-targeted therapies. Two patients experienced a CE and 1 had an asymptomatic worsening of LVEF to 35%.ConclusionThis study provides safety data of HER2-targeted therapies in patients with breast cancer and reduced LVEF while receiving cardioprotective medications and close cardiac monitoring. Our results demonstrate the importance of collaboration between cardiology and oncology providers to allow for delivery of optimal oncologic care to this unique population.
Keywords: paclitaxel; breast cancer; adjuvant chemotherapy; her2; pertuzumab; randomized-trial; prevention; trial comparing doxorubicin; dysfunction; cardiac dysfunction; her2-targeted therapy; cardiac safety; carvedilol; plus trastuzumab
Journal Title: Breast Cancer Research and Treatment
Volume: 175
Issue: 3
ISSN: 0167-6806
Publisher: Springer  
Date Published: 2019-06-01
Start Page: 595
End Page: 603
Language: English
ACCESSION: WOS:000469014200007
DOI: 10.1007/s10549-019-05191-2
PROVIDER: wos
PMCID: PMC6534513
PUBMED: 30852761
Notes: Source: Wos
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MSK Authors
  1. Chau Dang
    201 Dang
  2. Anthony Yu
    50 Yu