N I Bouwer1,2, T G Steenbruggen3, J van Rosmalen4, H N Rier5, J J E M Kitzen6, M L van Bekkum7, A J Ten Tije8, P C de Jong9, J C Drooger10, C Holterhues11, C H Smorenburg3, M J M Kofflard12, E Boersma13, G S Sonke3, M-D Levin6, A Jager5. 1. Department of Internal Medicine, Albert Schweitzer Hospital, 3300 AK, Dordrecht, South-Holland, The Netherlands. n.i.bouwer@asz.nl. 2. Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands. n.i.bouwer@asz.nl. 3. Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands. 4. Department of Biostatistics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands. 5. Department of Medical Oncology, Erasmus MC, Cancer Institute, Rotterdam, The Netherlands. 6. Department of Internal Medicine, Albert Schweitzer Hospital, 3300 AK, Dordrecht, South-Holland, The Netherlands. 7. Department of Medical Oncology, Reinier de Graaf Hospital, Delft, The Netherlands. 8. Department of Medical Oncology, Amphia Hospital, Breda, The Netherlands. 9. Department of Medical Oncology, Sint Antonius Hospital, Utrecht, The Netherlands. 10. Department of Medical Oncology, Ikazia Hospital, Rotterdam, The Netherlands. 11. Department of Medical Oncology, Haga Hospital, The Hague, The Netherlands. 12. Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands. 13. Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
Abstract
PURPOSE: Patients with HER2-positive metastatic breast cancer (MBC) usually receive many years of trastuzumab treatment. It is unknown whether these patients require continuous left ventricular ejection fraction (LVEF) monitoring. We studied a real-world cohort to identify risk factors for cardiotoxicity to select patients in whom LVEF monitoring could be omitted. METHODS: We included patients with HER2-positive MBC who received > 1 cycle of trastuzumab-based therapy in eight Dutch hospitals between 2000 and 2014. Cardiotoxicity was defined as LVEF < 50% that declined > 10%-points and was categorized into non-severe cardiotoxicity (LVEF 40-50%) and severe cardiotoxicity (LVEF < 40%). Multivariable Cox and mixed model analyses were performed to identify risk factors associated with cardiotoxicity. Additionally, we explored the reversibility of cardiotoxicity in patients who continued trastuzumab. RESULTS: In total, 429 patients were included. Median follow-up for cardiotoxicity was 15 months (interquartile range 8-31 months). The yearly incidence of non-severe + severe cardiotoxicity in the first and second year was 11.7% and 9.1%, respectively, which decreased thereafter. The yearly incidence of severe cardiotoxicity was low (2.8%) and stable over time. In non-smoking patients with baseline LVEF > 60% and no cardiotoxicity during prior neoadjuvant/adjuvant treatment, the cumulative incidence of severe cardiotoxicity was 3.1% after 4 years of trastuzumab. Despite continuing trastuzumab, LVEF decline was reversible in 56% of patients with non-severe cardiotoxicity and in 33% with severe cardiotoxicity. CONCLUSIONS: Serial cardiac monitoring can be safely omitted in non-smoking patients with baseline LVEF > 60% and without cardiotoxicity during prior neoadjuvant/adjuvant treatment.
PURPOSE:Patients with HER2-positive metastatic breast cancer (MBC) usually receive many years of trastuzumab treatment. It is unknown whether these patients require continuous left ventricular ejection fraction (LVEF) monitoring. We studied a real-world cohort to identify risk factors for cardiotoxicity to select patients in whom LVEF monitoring could be omitted. METHODS: We included patients with HER2-positive MBC who received > 1 cycle of trastuzumab-based therapy in eight Dutch hospitals between 2000 and 2014. Cardiotoxicity was defined as LVEF < 50% that declined > 10%-points and was categorized into non-severe cardiotoxicity (LVEF 40-50%) and severe cardiotoxicity (LVEF < 40%). Multivariable Cox and mixed model analyses were performed to identify risk factors associated with cardiotoxicity. Additionally, we explored the reversibility of cardiotoxicity in patients who continued trastuzumab. RESULTS: In total, 429 patients were included. Median follow-up for cardiotoxicity was 15 months (interquartile range 8-31 months). The yearly incidence of non-severe + severe cardiotoxicity in the first and second year was 11.7% and 9.1%, respectively, which decreased thereafter. The yearly incidence of severe cardiotoxicity was low (2.8%) and stable over time. In non-smoking patients with baseline LVEF > 60% and no cardiotoxicity during prior neoadjuvant/adjuvant treatment, the cumulative incidence of severe cardiotoxicity was 3.1% after 4 years of trastuzumab. Despite continuing trastuzumab, LVEF decline was reversible in 56% of patients with non-severe cardiotoxicity and in 33% with severe cardiotoxicity. CONCLUSIONS: Serial cardiac monitoring can be safely omitted in non-smoking patients with baseline LVEF > 60% and without cardiotoxicity during prior neoadjuvant/adjuvant treatment.
Entities:
Keywords:
Cardiotoxicity; HER2-positive metastatic breast cancer; LVEF monitoring; Screening for cardiotoxicity; Trastuzumab treatment
Authors: Nathalie I Bouwer; Crista Liesting; Marcel J M Kofflard; Jasper J Brugts; Marc C J Kock; Jos J E M Kitzen; Mark-David Levin; Eric Boersma Journal: Cardiovasc Ultrasound Date: 2021-11-09 Impact factor: 2.062
Authors: Nathalie I Bouwer; Tessa G Steenbruggen; Hánah N Rier; Jos J E M Kitzen; Carolien H Smorenburg; Marlies L van Bekkum; Paul C de Jong; Jan C Drooger; Cynthia Holterhues; Marcel J M Kofflard; Eric Boersma; Gabe S Sonke; Mark-David Levin; Agnes Jager Journal: Int J Cancer Date: 2022-04-27 Impact factor: 7.316
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