Cardiac safety of reduced cardiotoxicity surveillance during HER2-targeted therapy Journal Article
| Authors: | Yu, A. F.; Dang, C. T.; Moskowitz, C. S.; Mishra Meza, A.; DeFusco, P.; Oligino, E.; Chen, C. L.; Sanford, R.; Drullinsky, P.; Bromberg, J.; Wong, S.; Modi, S.; Jorgensen, J.; Oeffinger, K. C.; Steingart, R. M.; Liu, J. E. |
| Article Title: | Cardiac safety of reduced cardiotoxicity surveillance during HER2-targeted therapy |
| Abstract: | Background: Echocardiograms are recommended every 3 months to monitor for cancer therapy–related cardiac dysfunction (CTRCD) among patients treated with HER2-targeted therapy, despite increasing use of safer regimens associated with low CTRCD risk. Objectives: This study evaluated the cardiac safety of reduced CTRCD surveillance performed every 6 months during non-anthracycline HER2-targeted treatment. Methods: This non-randomized clinical trial enrolled 190 patients with HER2-positive breast cancer treated with non-anthracycline HER2-targeted therapy. CTRCD surveillance by means of echocardiography was performed every 6 months. Key exclusion criteria were previous anthracycline exposure, significant cardiovascular disease, and uncontrolled hypertension. The primary outcome was the cardiac event rate, defined by heart failure or cardiovascular death at 1 year. Secondary outcomes included change in LVEF from baseline to 6 months and 1 year, incidence of asymptomatic CTRCD, incidence of HER2-targeted treatment interruption, and feasibility of reduced cardiac surveillance. Results: The median age was 52 years (Q1-Q3: 45-60 years); 174 (91.6%) had stage I-III disease, and all were treated with a trastuzumab-based regimen. Cardiovascular risk factors included hypertension (20.0%) and diabetes (4.2%), and the mean left ventricular ejection fraction at baseline was 63.6 ± SE 0.3%. There were 0 (0%; 1-sided 97.5% CI: 0%-1.9%) cardiac events with a median follow-up of 17.5 months (Q1-Q3: 16.3-18.9 months). One patient developed asymptomatic CTRCD (0.5%; 95% CI: 0.01%-2.9%) but resumed therapy after a temporary treatment interruption. Adherence to the reduced CTRCD surveillance schedule every 6 months was 73.2% (intention-to-treat) and 79.9% (per-protocol). Conclusions: Reduced CTRCD surveillance every 6 months is safe and feasible for patients at low risk for CTRCD and may be an appropriate strategy to consider during non-anthracycline HER2-targeted treatment regimens. © 2025 The Authors |
| Keywords: | adult; cancer chemotherapy; middle aged; major clinical study; drug safety; hypertension; paclitaxel; cancer staging; follow up; carboplatin; breast cancer; incidence; epidermal growth factor receptor 2; cyclophosphamide; docetaxel; feasibility study; heart failure; cardiotoxicity; diabetes mellitus; patient safety; echocardiography; trastuzumab; heart left ventricle ejection fraction; cardiomyopathy; pertuzumab; disease surveillance; cardiovascular risk factor; molecularly targeted therapy; medication compliance; asymptomatic disease; human epidermal growth factor receptor 2 positive breast cancer; human; female; article; vinorelbine tartrate; her2 therapy |
| Journal Title: | JACC: CardioOncology |
| Volume: | 7 |
| Issue: | 4 |
| ISSN: | 2666-0873 |
| Publisher: | American College of Cardiology |
| Date Published: | 2025-06-01 |
| Start Page: | 430 |
| End Page: | 441 |
| Language: | English |
| DOI: | 10.1016/j.jaccao.2025.05.006 |
| PROVIDER: | scopus |
| PMCID: | 40537192 |
| PUBMED: | PMC12228139 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledge in the PDF -- Corresponding authors is MSK author: Anthony F. Yu -- Source: Scopus |
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