A Prospective Study About Trastuzumab-induced Cardiotoxicity in HER2-positive Breast Cancer

Abstract

Background: Trastuzumab improves therapeutic outcomes among patients with human epidermal growth factor receptor 2–positive breast cancer (BC). However, it is associated with a risk of treatment-induced cardiotoxicity. The aims of this study were to determine the frequency of trastuzumab-induced cardiotoxicity (TIC) in Tunisian patients, to study the effects of trastuzumab on cardiac biomarkers and echocardiographic parameters using the speckle tracking technique and to identify risk factors of occurrence of TIC. Patients and Methods: Fifty women with newly diagnosed human epidermal growth factor receptor 2–positive BC treated with or without anthracycline followed by taxane and trastuzumab were enrolled, from November 2016 to December 2018, to be evaluated every 3 months during trastuzumab treatment (total of 15 mo) using echocardiograms and blood samples. Left ventricular ejection fraction (LVEF) and peak systolic left ventricular longitudinal myocardial strain were calculated. Ultrasensitive troponin I (TNI) and N-terminal pro–B-type natriuretic peptide (NT pro-BNP) were also measured. Results: LVEF decreased from 62±3.12% to 59±3.3% (P=0.005) over 15 months. Seven patients (14%) developed cardiotoxicity, as defined by the European Society of Cardiology; of these patients, 2 (4%) had symptoms of heart failure. Hypertension, left ventricular longitudinal myocardial strain, Log TNI, and NT pro-BNP measured at the completion of anthracyclines were significantly correlated to TIC occurrence. At multivariate analysis, the degree of LVEF decline was the only independent factor correlated to TIC (hazard ratio=2.4; 95% confidence interval=1.2-6.03; P=0.049). This TIC was reversible in 86% of cases. Conclusion: In patients with BC treated with trastuzumab, in addition to the evaluation of the LVEF, systolic longitudinal strain, TNI, and NT pro-BNP measured at the completion of anthracyclines are useful in the prediction of subsequent TIC.

The Value of Troponin as a Biomarker of Chemotherapy-Induced Cardiotoxicity

“…The patients who received a combination of drugs with AC prior to trastuzumab were more likely to present with positive levels of cTnI, suggesting that the high levels of cTn were determined by the preexisting myocardial damage secondary to the AC treatment [ 21 ]. Similar results, confirming that the levels of us-cTnI at the end of AC treatment were a predictor of cardiotoxicity in patients treated with trastuzumab, were demonstrated by a study performed in Tunisia [ 66 ].…”

A first approach to identifying cardiotoxic effects of breast cancer chemotherapeutic treatment in Kazakhstan

“…due to the direct effect of anticancer therapy; 2) accelerating the development of CV diseases in the presence of conventional CV risk factors [17]. It has been established that the risk of left ventricular dysfunction or the development of heart failure in patients with existing CV risk factors increases with the administration tyrosine kinase inhibitors; prescribing Trastuzumab simultaneously with or after Anthracyclines, or even without them; with radiation therapy in combination with chemotherapy, especially with cancer of the left breast; when prescribing VEGF inhibitors [6,18]. Antineoplastic drugs for the treatment of breast cancer cause both early and delayed (late-onset) cardiotoxic effects.…”

Left ventricular ejection fraction and cardiac biomarkers for dynamic prediction of cardiotoxicity in early breast cancer

“…This also applied to the 10.3389/fcvm.2022.933428 potential cardiotoxic effects of concurrent anthracyclines, which were given to a non-negligible proportion of women in this cohort and may have further modified cardiotoxicity risk but also biomarker trajectories. Finally, emerging cardio-oncologic echocardiography techniques, including measurements of global longitudinal strain by speckle tracking or diastolic dysfunction (20,(24)(25)(26)(27), were not available.…”