Continuous trastuzumab therapy in breast cancer patients with asymptomatic left ventricular dysfunction Journal Article

Authors: Yu, A. F.; Yadav, N. U.; Eaton, A. A.; Lung, B. Y.; Thaler, H. T.; Liu, J. E.; Hudis, C. A.; Dang, C. T.; Steingart, R. M.
Article Title: Continuous trastuzumab therapy in breast cancer patients with asymptomatic left ventricular dysfunction
Abstract: 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 treatment-induced 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 between candidate risk factors and treatment-induced cardiotoxicity. Results. Among 573 patients, 92 (16%) developed treatment-induced cardiotoxicity. Trastuzumab was continued without interruption in 31 of 92 patients with treatment-induced cardiotoxicity—all were asymptomatic with LVEF of ≥50% at cardiotoxicity diagnosis with median LVEF of 53% (range, 50%–63%), and none developed heart failure during follow-up. Risk factors associated with treatment-induced cardiotoxicity included age (p = .011), anthracycline chemotherapy (p = .002), and lower pretrastuzumab LVEF (p < .001). Conclusion. Among patients who develop asymptomatic treatment-induced cardiotoxicity with LVEF of ≥50%, continuous trastuzumab therapy appears to be safe. © AlphaMed Press 2015.
Keywords: adult; aged; major clinical study; doxorubicin; fluorouracil; heart left ventricle failure; paclitaxel; methotrexate; disease association; carboplatin; breast cancer; tumor volume; epidermal growth factor receptor 2; cyclophosphamide; retrospective study; docetaxel; cardiovascular disease; cardiovascular risk; heart failure; adjuvant chemotherapy; cardiotoxicity; epirubicin; trastuzumab; anthracycline; heart left ventricle ejection fraction; beta adrenergic receptor blocking agent; dipeptidyl carboxypeptidase inhibitor; angiotensin receptor antagonist; cardiovascular system examination; very elderly; human; female; priority journal; article; two dimensional echocardiography; multigated acquisition scan
Journal Title: The Oncologist
Volume: 20
Issue: 10
ISSN: 1083-7159
Publisher: AlphaMed Press  
Date Published: 2015-10-01
Start Page: 1105
End Page: 1110
Language: English
DOI: 10.1634/theoncologist.2015-0125
PROVIDER: scopus
PMCID: PMC4591940
PUBMED: 26240135
Notes: Export Date: 2 November 2015 -- Source: Scopus
Citation Impact
MSK Authors
  1. Jennifer Liu
    49 Liu
  2. Clifford Hudis
    891 Hudis
  3. Chau Dang
    201 Dang
  4. Richard M Steingart
    132 Steingart
  5. Anne Austin Eaton
    122 Eaton
  6. Howard T Thaler
    227 Thaler
  7. Nandini Umesh Yadav
    9 Yadav
  8. Anthony Yu
    50 Yu
  9. Betty Ying-Feng Lung
    6 Lung