Trastuzumab-related cardiotoxicity in patients with nonlimiting cardiac comorbidity
Rossella Martinello1, Paolo Becco2, Patrizia Vici3
1Medical Oncology, Cardinal Massaia Hospital, Asti, Italy.
Insights
Adjuvant trastuzumab is generally contraindicated with symptomatic cardiac issues. However, this study found that trastuzumab can be safely administered to breast cancer patients with asymptomatic cardiac conditions.
Area of Science:
- Oncology
- Cardiology
- Pharmacology
Background:
- Symptomatic cardiac comorbidity contraindicates adjuvant trastuzumab in breast cancer.
- Patients with asymptomatic cardiac comorbidity and normal left ventricular ejection fraction (LVEF) may receive trastuzumab.
- This study evaluated trastuzumab tolerability in such patients.
Purpose of the Study:
- To assess the safety and tolerability of adjuvant trastuzumab in breast cancer patients with asymptomatic, nonlimiting cardiac comorbidities.
- To determine the incidence of cardiac events during trastuzumab treatment in this specific patient population.
Main Methods:
- Retrospective analysis of 37 HER2-positive breast cancer patients with asymptomatic cardiac comorbidity.
- Data collected from six institutions between July 2007 and January 2016.
- Evaluation of cardiac events and left ventricular ejection fraction (LVEF) changes during treatment.
Main Results:
- Nine patients (24.3%) experienced cardiac events, including asymptomatic LVEF reduction (16%) and rhythm disturbances (5%).
- Trastuzumab was discontinued in 14% of patients due to cardiac events.
- Most patients maintained normal LVEF post-treatment, with one experiencing a symptomatic cardiac event.
Conclusions:
- Nonlimiting cardiac comorbidity should not prevent adjuvant trastuzumab treatment when beneficial for breast cancer outcomes.
- Caution is advised for patients with significant cardiovascular risk factors.
- Trastuzumab can be a viable option for selected breast cancer patients with asymptomatic cardiac conditions.
Background:
Significant and symptomatic cardiac comorbidity is a contraindication to adjuvant trastuzumab in breast cancer patients. However, some patients with asymptomatic, nonlimiting cardiac comorbidity and normal baseline left ventricular ejection fraction (LVEF) receive adjuvant trastuzumab in the clinical practice. We sought to describe the tolerability of trastuzumab in these patients.
Patients And Methods:
Retrospective analysis of patients with baseline asymptomatic, nonlimiting cardiac comorbidity receiving adjuvant trastuzumab at six Institutions between July 2007 and January 2016.
Results:
Thirty-seven patients with HER2-positive, surgery treated breast cancer at high risk of relapse were studied. Median age was 64 years (range 36-82), median baseline LVEF 61% (range 50%-85%). Thirteen patients (35%) received trastuzumab with adjuvant anthracycline and taxane-based regimens, 19 (51%) with taxane-based, three (8%) with off-label vinorelbine and two (5%) with off-label endocrine therapy. Most frequent cardiac comorbidities were ischemic heart disease (35%), valvular disease (30%), atrial fibrillation (19%), and conduction disorders (14%). Nine patients (24.3%) experienced a cardiac event: congestive heart failure (one patient, 3%), asymptomatic LVEF reduction (six patients, 16%), and rhythm disturbances (two patients, 5%). Trastuzumab had to be discontinued either permanently (five patients, 14%) or temporarily (two patients, 5%). At the time of last follow-up visit, all patients showed LVEF within normal limits, except one who had experienced a symptomatic cardiac event (LVEF value at last follow-up 46%).
Conclusions:
Caution is needed in patients with significant ongoing cardiovascular risk factors, but when adjuvant trastuzumab is deemed beneficial on breast cancer outcomes, nonlimiting cardiac comorbidity should not preclude treatment.
More Related Videos
Related Concept Videos
01:22Cardiac Output II: Effect of Stroke Volume on Cardiac Output
Preload
Preload refers to the initial elongation of the cardiac myocytes before contraction and is related to the volume of blood filling the heart at the end of diastole, or end-diastolic volume. The...
01:19Cardiac Output I:Effect of Heart Rate on Cardiac Output
Cardiac output (CO) refers to the total amount of blood ejected by one of the ventricles in liters per minute (L/min). In a resting adult, CO ranges from 5 to 6 L/min, adjusting according to the body's metabolic requirements.
Effect of Heart Rate on Cardiac Output
Cardiac output adapts to metabolic demands during stress, physical activity, or illness. The autonomic nervous system regulates heart rate via the sinoatrial node. The parasympathetic nervous system decreases heart...
01:29Cardiac Cycle
During the cardiac cycle, blood flow through the heart is regulated entirely by changing pressure gradients. This sequence of events begins with the heart in a state of total relaxation, known as mid-to-late diastole, during which blood passively flows from...
01:13The Cardiac Cycle
The Process
Electrical signals—sent from the sinoatrial (SA) node in the right atrial wall to the atrioventricular (AV) node between the right atrium and right ventricle—cause both atria to simultaneously contract. When the signal reaches the AV node, it pauses for approximately a tenth of a second, allowing the atria to contract and...
01:17Exercise and Cardiac Output
Sustained exercise increases the muscles' oxygen demand, which can be...
01:26Imbalances in Cardiac Output
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...