C C Barron1, M M Alhussein1, U Kaur2, T L Cosman3,4, N K Tyagi5, M Brown3, S D Mukherjee5, P M Ellis5, S Dhesy-Thind5, D P Leong1,6,7. 1. Department of Medicine, McMaster University, Hamilton, ON. 2. Department of Medicine, University of Western Ontario, London, ON. 3. Hamilton Health Sciences, Juravinski Hospital and Cancer Centre, Hamilton, ON. 4. School of Nursing, McMaster University, Hamilton, ON. 5. Department of Oncology, McMaster University, Hamilton, ON. 6. The Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON. 7. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON.
Abstract
Background: The major limitation in the use of trastuzumab therapy is cardiotoxicity. We evaluated the safety of a strategy of continuing trastuzumab in patients with breast cancer despite mild, asymptomatic left ventricular impairment. Methods: Charts of consecutive patients referred to a cardio-oncology clinic from January 2015 to March 2017 for decline in left ventricular ejection fraction (lvef), defined as a fall of 10 percentage points or more, or a value of less than 50% during trastuzumab therapy, were reviewed. The primary outcome of interest was change in lvef, measured before and during trastuzumab exposure and up to 3 times after initiation of cardiac medications during a median of 9 months. Results: All 18 patients referred for decline in lvef chose to remain on trastuzumab and were included. All patients were treated with angiotensin converting-enzyme inhibitors or beta-blockers, or both. After initiation of cardiac medications, lvef increased over time by 4.6 percentage points (95% confidence interval: 1.9 percentage points to 7.4 percentage points), approaching baseline values. Of the 18 patients, 17 (94%) were asymptomatic at all future visits. No deaths occurred in the group. Conclusions: Many patients with mildly reduced lvef and minimal heart failure symptoms might be able to continue trastuzumab without further decline in lvef, adverse cardiac events, or death when treated under the supervision of a cardiologist with close follow-up.
Background: The major limitation in the use of trastuzumab therapy is cardiotoxicity. We evaluated the safety of a strategy of continuing trastuzumab in patients with breast cancer despite mild, asymptomatic left ventricular impairment. Methods: Charts of consecutive patients referred to a cardio-oncology clinic from January 2015 to March 2017 for decline in left ventricular ejection fraction (lvef), defined as a fall of 10 percentage points or more, or a value of less than 50% during trastuzumab therapy, were reviewed. The primary outcome of interest was change in lvef, measured before and during trastuzumab exposure and up to 3 times after initiation of cardiac medications during a median of 9 months. Results: All 18 patients referred for decline in lvef chose to remain on trastuzumab and were included. All patients were treated with angiotensin converting-enzyme inhibitors or beta-blockers, or both. After initiation of cardiac medications, lvef increased over time by 4.6 percentage points (95% confidence interval: 1.9 percentage points to 7.4 percentage points), approaching baseline values. Of the 18 patients, 17 (94%) were asymptomatic at all future visits. No deaths occurred in the group. Conclusions: Many patients with mildly reduced lvef and minimal heart failure symptoms might be able to continue trastuzumab without further decline in lvef, adverse cardiac events, or death when treated under the supervision of a cardiologist with close follow-up.
Entities:
Keywords:
Breast cancer; cardio-oncology; cardiotoxicity; her2; trastuzumab
Authors: Suchi Grover; Darryl P Leong; Adhiraj Chakrabarty; Lucas Joerg; Dusan Kotasek; Kerry Cheong; Rohit Joshi; Majo X Joseph; Carmine DePasquale; Bogda Koczwara; Joseph B Selvanayagam Journal: Int J Cardiol Date: 2013-08-02 Impact factor: 4.164
Authors: Clyde W Yancy; Mariell Jessup; Biykem Bozkurt; Javed Butler; Donald E Casey; Monica M Colvin; Mark H Drazner; Gerasimos S Filippatos; Gregg C Fonarow; Michael M Givertz; Steven M Hollenberg; JoAnn Lindenfeld; Frederick A Masoudi; Patrick E McBride; Pamela N Peterson; Lynne Warner Stevenson; Cheryl Westlake Journal: J Am Coll Cardiol Date: 2017-04-28 Impact factor: 24.094
Authors: Michael S Ewer; Mary T Vooletich; Jean-Bernard Durand; Myrshia L Woods; Joseph R Davis; Vicente Valero; Daniel J Lenihan Journal: J Clin Oncol Date: 2005-11-01 Impact factor: 44.544
Authors: Thomas M Suter; Marion Procter; Dirk J van Veldhuisen; Michael Muscholl; Jonas Bergh; Chiara Carlomagno; Timothy Perren; Rodolfo Passalacqua; Claudia Bighin; Jan G M Klijn; Fail T Ageev; Erika Hitre; Juergen Groetz; Hiroji Iwata; Malgorzata Knap; Michael Gnant; Susanne Muehlbauer; Alison Spence; Richard D Gelber; Martine J Piccart-Gebhart Journal: J Clin Oncol Date: 2007-07-23 Impact factor: 44.544
Authors: Paaladinesh Thavendiranathan; Frédéric Poulin; Ki-Dong Lim; Juan Carlos Plana; Anna Woo; Thomas H Marwick Journal: J Am Coll Cardiol Date: 2014-04-02 Impact factor: 24.094
Authors: Jose Luis Zamorano; Patrizio Lancellotti; Daniel Rodriguez Muñoz; Victor Aboyans; Riccardo Asteggiano; Maurizio Galderisi; Gilbert Habib; Daniel J Lenihan; Gregory Y H Lip; Alexander R Lyon; Teresa Lopez Fernandez; Dania Mohty; Massimo F Piepoli; Juan Tamargo; Adam Torbicki; Thomas M Suter Journal: Eur Heart J Date: 2016-08-26 Impact factor: 29.983
Authors: J R Mackey; M Clemons; M A Côté; D Delgado; S Dent; A Paterson; L Provencher; M B Sawyer; S Verma Journal: Curr Oncol Date: 2008-01 Impact factor: 3.677
Authors: Anna Calleja; Frédéric Poulin; Ciril Khorolsky; Masoud Shariat; Philippe L Bedard; Eitan Amir; Harry Rakowski; Michael McDonald; Diego Delgado; Paaladinesh Thavendiranathan Journal: J Oncol Date: 2015-08-03 Impact factor: 4.375
Authors: Carly C Barron; Nidhi Kumar Tyagi; Muhammad Mustafa Alhussein; Som D Mukherjee; Peter M Ellis; Sukhbinder Dhesy-Thind; Darryl P Leong Journal: Oncologist Date: 2019-07-17
Authors: Katia Khoury; Filipa Lynce; Ana Barac; Xue Geng; Chau Dang; Anthony F Yu; Karen L Smith; Christopher Gallagher; Paula R Pohlmann; Raquel Nunes; Pia Herbolsheimer; Robert Warren; Monvadi B Srichai; Mark Hofmeyer; Federico Asch; Ming Tan; Claudine Isaacs; Sandra M Swain Journal: Breast Cancer Res Treat Date: 2021-01-05 Impact factor: 4.872
Authors: Darryl P Leong; Tammy Cosman; Muhammad M Alhussein; Nidhi Kumar Tyagi; Sarah Karampatos; Carly C Barron; Douglas Wright; Vikas Tandon; Patrick Magloire; Philip Joseph; David Conen; P J Devereaux; Peter M Ellis; Som D Mukherjee; Sukhbinder Dhesy-Thind Journal: JACC CardioOncol Date: 2019-07-17