Cardiotoxicity surveillance and risk of heart failure during HER2 targeted therapy Journal Article


Authors: Yu, A. F.; Moskowitz, C. S.; Chuy, K. L.; Yang, J.; Dang, C. T.; Liu, J. E.; Oeffinger, K. C.; Steingart, R. M.
Article Title: Cardiotoxicity surveillance and risk of heart failure during HER2 targeted therapy
Abstract: BACKGROUND Guidelines recommend left ventricular ejection fraction (LVEF) assessments every 3 months for cardiotoxicity monitoring during human epidermal growth factor receptor 2 (HER2) targeted therapy. Evidence in support of this practice is lacking. OBJECTIVES This study examines the association between adherence to cardiotoxicity surveillance guidelines and heart failure (HF) in HER2-positive breast cancer patients. METHODS A case-control study was performed in 53 patients who developed cardiotoxicity during HER2 targeted therapy, and 159 controls matched by age, anthracycline exposure, and year of treatment. Cardiotoxicity was defined as HF (New York Heart Association functional class III or IV) or cardiac death. Adherence to cardiotoxicity surveillance guidelines was ascertained from the beginning of HER2 targeted therapy to the diagnosis date of HF for cases or the corresponding timepoint for matched controls. Conditional logistic regression was used for case-control comparisons. RESULTS Eighty-one percent of cases and controls were previously treated with an anthracycline. Adherence to cardiotoxicity surveillance guidelines during the entire observation period or during the first 6 months of treatment was not associated with lower risk of HF. An LVEF <55% at any surveillance timepoint was identified in 49% of cases and 3% of controls, and an LVEF <55% during the final surveillance timepoint before developing HF was identified in 54% of cases and 4% of controls. In multivariable-adjusted analyses, LVEF <55% at any timepoint or during the final surveillance timepoint (odds ratio: 27.0; 95% confidence interval: 9.3 to 78.8 and odds ratio: 25.6; 95% confidence interval: 7.3 to 90.3, respectively) was associated with HF. CONCLUSIONS Patients with LVEF <55% on routine surveillance during HER2 targeted therapy are at increased risk for HF. Additional studies to define their optimal management are warranted. (C) 2020 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.
Keywords: chemotherapy; breast cancer; heart failure; cardiotoxicity; candesartan; adjuvant trastuzumab; breast-cancer; association; randomized-trial; prevention; dysfunction; american society; cardiac; cardio-oncology; cardiac monitoring
Journal Title: JACC: CardioOncology
Volume: 2
Issue: 2
ISSN: 2666-0873
Publisher: American College of Cardiology  
Date Published: 2020-06-01
Start Page: 166
End Page: 175
Language: English
ACCESSION: WOS:000613114100003
DOI: 10.1016/j.jaccao.2020.03.002
PROVIDER: wos
PMCID: PMC7584138
PUBMED: 33103123
Notes: Article -- Source: Wos
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MSK Authors
  1. Jennifer Liu
    119 Liu
  2. Chau Dang
    272 Dang
  3. Richard M Steingart
    175 Steingart
  4. Chaya S. Moskowitz
    280 Moskowitz
  5. Anthony Yu
    92 Yu