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- Title
Continuous Trastuzumab Therapy in Breast Cancer Patients With Asymptomatic Left Ventricular Dysfunction.
- Authors
Yu, Anthony F.; Yadav, Nandini U.; Eaton, Anne A.; Lung, Betty Y.; Thaler, Howard T.; Liu, Jennifer E.; Hudis, Clifford A.; Dang, Chau T.; Steingart, Richard M.
- Abstract
Background. Adjuvant trastuzumab is a highly effective targeted treatment that improves survival for patients with HER2-positive breast cancer. However, trastuzumab interruption is recommended for patients who develop treatment-induced cardiotoxicity (i.e., decline in left ventricular ejection fraction [LVEF], with or without symptoms) and can lead to an incomplete course of treatment. We studied the cardiac safety of continuous trastuzumab therapy among patients with asymptomatic declines in LVEF. Methods. We retrospectively evaluated patients with HER2-positive breast cancer treated with adjuvant trastuzumab at our institution between 2005 and 2010. Treatment-induced cardiotoxicity was defined by an absolute decrease in LVEF of ≥10% to below 55% or an absolute decrease of ≥16%. Logistic regression was used to determine the association between candidate risk factors and treatment-induced cardiotoxicity. Results. Among 573 patients, 92 (16%) developed treatment-induced cardiotoxicity. Trastuzumab was continued without interruption in 31 of 92 patients with treatment-induced cardiotoxicity--all were asymptomatic with LVEF of ≥50% at cardiotoxicity diagnosis with median LVEF of 53% (range, 50%-63%), and none developed heart failure during follow-up. Risk factors associated with treatment-induced cardiotoxicity included age (p = .011), anthracycline chemotherapy (p 5 .002), and lower pretrastuzumab LVEF (p < .001). Conclusion. Among patients who develop asymptomatic treatment-induced cardiotoxicity with LVEF of ≥50%, continuous trastuzumab therapy appears to be safe.
- Subjects
NEW York (State); ANTHRACYCLINES; AGE distribution; HEART ventricle diseases; BREAST tumors; CANCER chemotherapy; CARDIAC output; CARDIOTOXICITY; CONFIDENCE intervals; HEART beat; LEFT heart ventricle; SAFETY; T-test (Statistics); TRASTUZUMAB; LOGISTIC regression analysis; RETROSPECTIVE studies; DATA analysis software; DESCRIPTIVE statistics; ODDS ratio; DIAGNOSIS; THERAPEUTICS
- Publication
Oncologist, 2015, Vol 20, Issue 10, p1105
- ISSN
1083-7159
- Publication type
Article
- DOI
10.1634/theoncologist.2015-0125