Authors: Anthony F Yu Nandini U Yadav Betty Y Lung Anne A Eaton Howard T Thaler Clifford A Hudis Chau T Dang Richard M Steingart
Publish Date: 2015/01/01
Volume: 149, Issue: 2, Pages: 489-495
Abstract
Trastuzumab improves outcomes among patients with HER2positive breast cancer but is associated with a risk of treatmentinduced cardiotoxicity TIC It is unclear how frequently TIC leads to trastuzumab interruption outside of prospective trials and how TIC is managed in clinical practice Patients with HER2postive breast cancer receiving adjuvant trastuzumab from 2005 to 2010 were identified n = 608 We evaluated the incidence risk factors and management of trastuzumab interruption due to TIC In total 488 80 patients were treated with anthracycline prior to trastuzumab Trastuzumab was interrupted in 108 18 patients Cumulative trastuzumab dose was lower in the interrupted group median 86 vs 108 mg/kg p 00001 The most common reason for interruption was TIC 66 of 108 patients 20 had symptomatic heart failure and 46 had asymptomatic left ventricular ejection fraction LVEF decline Patients with trastuzumab interruption for TIC were older 54 vs 50 years p = 0014 with lower LVEF before anthracycline 63 vs 67 p 00001 and trastuzumab 62 vs 67 p 00001 therapy Mean LVEF at baseline TIC diagnosis and followup after trastuzumab interruption was 63 45 and 55 respectively Thirtythree of 66 patients with TIC were rechallenged with trastuzumab and five patients had recurrent LVEF decline In clinical practice trastuzumab interruption is common and most often due to TIC with most patients receiving anthracycline prior to trastuzumab Cardiac dysfunction improves after trastuzumab interruption but may not fully recover to baseline Strategies to minimize cardiotoxicity and treatment interruption should be investigated to prevent persistent left ventricular dysfunction in affected patients
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