RT Journal Article
SR Electronic
T1 Trastuzumab-induced cardiotoxicity in early breast cancer patients: a retrospective study of possible risk and protective factors
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 634
OP 639
DO 10.1136/heartjnl-2012-303151
VO 99
IS 9
A1 Alberto Farolfi
A1 Elisabetta Melegari
A1 Michele Aquilina
A1 Emanuela Scarpi
A1 Toni Ibrahim
A1 Roberta Maltoni
A1 Samanta Sarti
A1 Lorenzo Cecconetto
A1 Elisabetta Pietri
A1 Cristiano Ferrario
A1 Anna Fedeli
A1 Marina Faedi
A1 Oriana Nanni
A1 Giovanni Luca Frassineti
A1 Dino Amadori
A1 Andrea Rocca
YR 2013
UL http://heart.bmj.com/content/99/9/634.abstract
AB Objective Although adjuvant trastuzumab improves survival in patients with HER2-positive early breast cancer, there is growing concern about the long-term effect of trastuzumab-induced cardiotoxicity (TIC). We retrospectively assessed the incidence of TIC and heart failure (HF) to identify possible risk and protective factors. Design Retrospective study. Setting Institute for Cancer Research and Treatment, Medical Oncology Department. Patients Consecutive patients who started adjuvant trastuzumab between 2007 and 2010. Main outcome Measures TIC was defined as an absolute left ventricular ejection fraction (LVEF) decrease ≥15 points from baseline or a LVEF<50%. Logistic regression was used to estimate OR and their 95% CI in order to evaluate the risk of TIC, considering potential cardiac risk factors (hypertension, hypercholesterolaemia, diabetes mellitus, smoke, cardiac ischaemia and previous chest radiotherapy) and protective factors (β-blockers, ACE inhibitors and/or angiotensin receptor blockers). Results Among 179 patients, 78 cases of TIC (44%, 95% CI 37% to 51%) and four cases of HF (2%, 95% CI 0% to 4%) were reported. 14 patients stopped trastuzumab as a result of TIC. None of the cardiac risk factors or concomitant cardiovascular medications altered the risk of TIC. A previous cumulative dose >240 mg/m2 of doxorubicin or >500 mg/m2 of epirubicin increased the risk of TIC compared with lower doses (OR 3.07; 95% CI 1.29 to 7.27, p=0.0011). Conclusions TIC is a frequent, albeit generally mild, adverse event in clinical practice. Further studies are warranted to better define the risk of and protective factors for TIC.