Physician characteristics had more influence than measured patientlevel factors in the adequacy of cardiac monitoring. Nurses are instrumental in assessing, monitoring, and treating women receiving trastuzumab. Patients who develop cardiotoxicity while receiving trastuzumab therapy generally improve once use. Table shows fda guidelines for monitoring for cardiotoxicity with her2targeted therapies. Trastuzumab, pertuzumab, adotrastuzumab, cardiotoxicity, breast cancer, gastric cancer, risk factors. Trastuzumab and cardiotoxicity all about cardiovascular. In most patients, trastuzumabinduced cardiotoxicity tic is.
Risk factors of trastuzumabinduced cardiotoxicity in. To the best of our knowledge, this study is the first of its kind to estimate cardiotoxicity rates and cardiac monitoring in american women with breast cancer using the marketscan database. Current standard of care is discontinuation of trastuzumab, which can lead to worse cancer outcomes. New research shows that for patients with earlystage her2positive breast cancer, perindopril, an angiotensinconverting enzyme inhibitor, and bisoprolol, a. Objectives this study sought to evaluate the safety of continuing trastuzumab in patients with human epidermal growth factor receptorpositive breast cancer who developed. Serial cardiac imaging performed in patients treated with cardiotoxic therapies such as trastuzumab has led to the detection of asymptomatic. Early detection of anthracycline cardiotoxicity and. Trastuzumab is a humanized monoclonal antibody that is. Anthracycline therapy is associated with an increase in the risk for developing heart failure with significant associated morbidity and mortality 1.
Statistical analysis was performed using stata software version 15. Her2 receptors present on the myocytes may have role in cardiotoxicity. The seer program, supported by the us national cancer institute nci. Trastuzumab and cardiac monitoring in breast cancer. Trastuzumabas a component of various chemotherapy regimens and as an agent for prolonged maintenance therapyhas been widely accepted by the oncology.
Summary of key trastuzumab trials including treatment protocols, strategies for monitoring for cardiac dysfunction, and reported rates of. Mechanisms of trastuzumabmediated cardiotoxicity are still evolving. Cardiotoxicity of trastuzumab given for 12 months compared to. Cardioprotective approaches to the management of patients. Significant and symptomatic cardiac comorbidity is a contraindication to adjuvant trastuzumab in breast cancer patients. Among patients who received trastuzumab, guidelineadherent cardiac monitoring was identified in 46. Serial assessment of left ventricular function with 2dimensional echocardiography or radionuclide ventriculography is. Association of hospital and physician case volumes with cardiac monitoring and cardiotoxicity during adjuvant trastuzumab treatment for breast cancer. Understanding the importance of monitoring cancer patients. Cardiac surveillance guidelines for trastuzumabcontaining therapy in earlystage breast cancer. Little is known regarding the rate of chemotherapyrelated cardiotoxicity and adherence to.
Costeffectiveness of cardiotoxicity monitoring american. Cardiotoxicity related to trastuzumab and related her2targeted agents will be presented here. Trastuzumab is a monoclonal antibody that targets the human epidermal growth factor receptor 2 her2, also called erbb2. The cardiotoxicity of other antineoplastic drugs, including anthracyclines and taxanes. Early detection and prediction of cardiotoxicity in. The retrospective cohort study examined the records of 18 540 canadian women diagnosed with earlystage breast cancer from 200712. Management of cardiac health in trastuzumabtreated. Implementing guidelines to promote adherence to recommended. Because trastuzumab related cardiotoxicity is reversible, efforts to improve the adequacy of cardiac monitoring are needed, particularly in vulnerable populations. Safety of continuing trastuzumab despite mild cardiotoxicity. Costeffectiveness of cardiotoxicity monitoring american college. Cardiotoxicity monitoring is most useful in clinical scenarios in which the incidence of cardiotoxicity is high, the cost of monitoring is low, and the treatment for cardiotoxicity is efficacious.
Trastuzumab, an epidermal growth factor receptor 2 her2 targeting humanized monoclonal antibody, has been approved for the treatment her2positive breast cancer and. Monitoring trastuzumab resistance and cardiotoxicity. Trastuzumabmediated cardiotoxicity was originally described in women with metastatic breast cancer. In the setting of trastuzumabinduced cardiotoxicity, it could allow to identify patients at higher risk that could benefit from prophylactic therapy, and also identify those who may recover from. The recent cardiac subanalysis of the hera study showed that, next to lower lvef prior to trastuzumab, the risk of trastuzumabrelated cardiotoxicity was higher in patients with. Trastuzumab cardiotoxicity in earlystage breast cancer. Management of cardiac health in trastuzumabtreated patients with breast cancer. Acute cardiotoxicity with concurrent trastuzumab and. Modeling trastuzumabrelated cardiotoxicity in vitro using. Given trastuzumabs potential for cardiac toxicity, its common coadministration with other cardiotoxic agents e. This metaanalysis aims to consolidate previously published data to identify the risk factors most likely leading to tic.
Background cardiotoxicity is the most common doselimiting toxicity associated with trastuzumab. Trastuzumab, a monoclonal directed against the human epidermal growth factor egf receptor2 her2, revolutionized her2positive breast cancer treatment, albeit, with the therapylimiting. In series of patients with trastuzumab cardiotoxicity, trastuzumab did not cause cardiac. Trastuzumab is used to treat certain types of breast cancer or stomach cancer, sometimes in combination with other cancer medicines. Clinical utility of routine cardiac monitoring in breast. Treatment of breast cancer with trastuzumab is complicated by cardiotoxicity in up to 34% of the patients. In other words, trastuzumab given in combination with other chemotherapy drugs may produce more severe side effects. Radiotherapy for patients with nonmetastatic human epidermal growth factor receptor 2 her2 positive breast cancer is commonly administered concurrently with adjuvant trastuzumab. Cardiac surveillance guidelines for trastuzumabcontaining. However, there is limited data on the use of concurrent trastuzumab and hypofractionated radiotherapy hyport, which is now standard of care for the majority of women receiving whole breast irradiation. Current techniques for detecting cardiotoxicity predominantly rely on.
In the adjuvant trastuzumab trials, monitoring of trastuzumabrelated cardiotoxicity has been performed by lvef measurement, either by multigated nuclear angiography or. The following side effects are common occurring in greater than. Objectives this study sought to determine the rate of chemotherapyrelated cardiotoxicity and to estimate adherence to recommendations for cardiac monitoring among. Trastuzumab causes type ii cardiotoxicity which may not be dose dependent, but reversible. Cardiac monitoring during adjuvant trastuzumabbased. Cardiotoxicity as an adverse effect of trastuzumab therapy did not become evident until phase iii clinical trials. Small benefits in trastuzumabrelated cardiotoxicity the.
The incidence rates were % when the antibody was administered. As the cardiotoxic mechanism of trastuzumab is fundamentally different, and the literature reports much less cardiotoxicity after trastuzumab therapy in general, few data on. A medline search of the literature was performed 1966august 2007. Clinical manifestations, monitoring, and diagnosis of.
Cardiotoxicity of trastuzumab in clinical practice nejm. A large proportion of patients had suboptimal cardiac monitoring. The anthracyclines and related compounds doxorubicin, daunorubicin, idarubicin, epirubicin, and the anthraquinone mitoxantrone are among the chemotherapeutic agents implicated in cardiotoxicity. One of the strategies pursued is decreasing trastuzumab treatment duration, with. In light of this worse cardiotoxicity profile, proper cardiac function monitoring. Chemotherapy, trastuzumab use, cardiac monitoring, and comorbidities were. Moreover, the phase 2 program focused on singleagent therapy and the interaction of. If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. These problems include trastuzumab resistance and trastuzumabinduced cardiotoxicity. Cardiotoxicity and cardiac monitoring among chemotherapy.
We describe the patterns of cardiac monitoring and evaluate factors. Cardiac monitoring among trastuzumabtreated patients should be a priority among highrisk patients and in the presence of comorbidities. Cardiotoxicity associated with the use of trastuzumab in. Trastuzumabassociated cardiac events in the persephone. Trastuzumab is available as a biosimilar medication. All calculations were computed by sas software package, version 9. Trastuzumab cardiomyopathy therapeutic intervention with. The earliest definition of cardiotoxicity during cancer treatment is from the work by alexander et al. Serial assessment of left ventricular function with 2dimensional echocardiography or radionuclide ventriculography is the most practical means of monitoring cardiotoxicity.
Objectives this study sought to evaluate the safety of continuing trastuzumab in patients with human epidermal growth factor receptorpositive breast cancer who developed mild cardiotoxicity. We report cardiac events in the persephone trial which compares 612 months of adjuvant trastuzumab in women with confirmed her2positive, earlystage breast cancer. Early detection and prediction of cardiotoxicity in chemotherapytreated patients article in the american journal of cardiology 1079. Cardiotoxicity from human epidermal growth factor receptor. Heart failure hf is a known complication associated with cancer therapies. For the 15 to 20 percent of patients with breast cancer whose tumors overexpress her2, trastuzumab therapy is important in the treatment of both early and advanced disease. A prospective trial of serial strain monitoring in patients receiving trastuzumab after a course of anthracycline showed that a gls of.
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