Cardiovascular Risk After Adjuvant Trastuzumab in Early Breast Cancer: An Italian Population-Based Cohort Study

Franchi, Matteo; Trama, Annalisa; Merlo, Ivan; Minicozzi, Pamela; Tarantini, Luigi; Garau, Donatella; Kirchmayer, Ursula; Martino, Mirko Di; Romero, Marilena; Carlo, Ilenia De; Scondotto, Salvatore; Apolone, Giovanni; Corrao, Giovanni

doi:10.1634/theoncologist.2020-0216

Cited by 7 publications

(11 citation statements)

References 30 publications

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“…For example, 6208 patients received T as part of their anti-cancer therapy experienced a significant short-term risk of cardiovascular diseases (hazard ratio (HR): 4.55; 95% CI: 2.58–8.01) compared to 12,416 matched patients who received chemotherapy without T or any other anti-Her2 treatment. 15 The OHERA prospective observational real-world study followed up 3733 patients with early BC on T-based adjuvant therapy. Symptomatic HF was reported in 2.8% of patients.…”

Section: Discussionmentioning

confidence: 99%

Cardiac function in women receiving dual anti-Her2 antibodies (trastuzumab and pertuzumab) combined with chemotherapy for breast cancer

Zekri

Rasool

Rizvi

et al. 2023

Womens Health (Lond Engl)

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Background: Chemotherapy regimens containing a combination of anti-Her2 antibodies are effective but can be associated with cardiac toxicity. Objectives: We evaluate the outcome with a particular focus on the cardiac function of patients with Her2 over-expressed breast cancer receiving Chemotherapy regimens combined with Trastuzumab and Pertuzumab in routine clinical practice settings. Design and methods: The initial cohort of patients who started Chemotherapy regimens in combination with Trastuzumab and Pertuzumab before September 2019 in four cancer units were reviewed retrospectively. All patients had regular measurements of left ventricular ejection fraction by Doppler ultrasound. Results: Sixty-seven patients were identified. Chemotherapy regimens in combination with Trastuzumab and Pertuzumab treatment were administered in the neoadjuvant and palliative settings in 28 (41.8%) and 39 (58.2%) patients, respectively. All patients underwent left ventricular ejection fraction assessment prior to starting Chemotherapy regimens in combination with Trastuzumab and Pertuzumab treatment and at 3 and 6 months later. Subsequently, left ventricular ejection fraction was measured at 9, 12, 15, 18, 21, and 24 months as long as patients are still receiving any of the treatment components. Compared to baseline, the mean left ventricular ejection fraction was not significantly different at any of the subsequent time points (range; decrease by 0.936% to increase by 1.087%: T-test P value not statistically significant for all comparisons). Trastuzumab and Pertuzumab administration was withheld temporarily for two patients due to clinically suspected cardiac toxicity which was excluded upon further investigations. In the neoadjuvant cohort, 82.3% of patients were relapse free at 3 years. The median progression-free survival was 20 months, and the median overall survival was 41 months in the palliative cohort. Conclusion: In this cohort describing our limited initial experience, dual anti-Her2 antibodies (Trastuzumab and Pertuzumab) combined with chemotherapy is effective and not associated with significant cardiac toxicity when the left ventricular ejection fraction is measured every 3 months. This may suggest that previous concerns about cardiotoxicity may have been overemphasized. Further studies investigating less frequent left ventricular ejection fraction monitoring may be warranted.

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Section: Discussionmentioning

confidence: 99%

Cardiac function in women receiving dual anti-Her2 antibodies (trastuzumab and pertuzumab) combined with chemotherapy for breast cancer

Zekri

Rasool

Rizvi

et al. 2023

Womens Health (Lond Engl)

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“…A study dissected 1,248 axillary lymph nodes of 72 patients with breast cancer and found that axillary lymph nodes with a length of less than 5.1 mm still had a 10.1% metastasis rate, the LNM rate of 5.2-9.1 mm was 17.4%, and the LNM rate of 10.2-20.1 mm was 19.8%. In addition, the rate of LNM with a long diameter greater than 19 mm was 41%, and there was no correlation between lymph node metastasis and the size and histological grade of the primary tumor [ 22 , 23 ]. Combining with the literature, it can be concluded that axillary lymph node diameter > 1.2 cm can be classified as metastasis, but lymph nodes < 1.2 cm cannot be excluded.…”

Section: Discussionmentioning

confidence: 99%

The Value of 320-Slice Spiral Computed Tomography Perfusion Imaging in Staging and Long-Term Dynamic Evaluation of Breast Cancer

Geng

Zhang

et al. 2022

Computational and Mathematical Methods in Medicine

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The value of 320-slice spiral computed tomography (CT) perfusion imaging in staging and long-term dynamic evaluation of breast cancer was explored. 120 breast cancer patients who underwent preoperative CT examination and were confirmed by surgery and pathology were selected. All patients underwent preoperative TNM staging of breast cancer, with 120 cases in each stage. According to the results of 320-slice spiral CT, the postoperative pathology and surgical methods were compared and analyzed. CT diagnosis of breast cancer showed that T1 sensitivity was 71% and accuracy was 61%, T2 sensitivity was 74% and accuracy was 64%, T3 sensitivity was 94% and the accuracy was 84%, and the T4 sensitivity was 100% and the accuracy was 91%. The sensitivity of N1 stage was 71%, and the accuracy was 61%; and the sensitivity of N2 ~ N3 stage was 81%, and the accuracy was 76%. There were 7 cases of M1 with distant metastasis, the sensitivity was 71%, and the accuracy was 71%. At T1 stage, blood flow (BF) was 39.2 ± 16.7 mL/min/100 g, blood volume (BV) was 2.66 ± 1.4 mL/100 g, mean transit time (MTT) was 8.16 ± 2.7 s, and permeability surface (PS) was 16.6 ± 9.7 mL/min/100 g. 320-slice spiral CT perfusion imaging technology provided a new diagnostic mode for everyone, which can quantitatively identify breast cancer with multiple parameters, which was of great significance for clinical auxiliary diagnosis.

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“…This implies that most patients with breast cancer in Asia are diagnosed before menopause and have few cardiovascular risk factors. Additionally, despite trastuzumab inducing cardiovascular complications from several different perspectives, previous studies focused only on myocardial dysfunction, such as HF, whereas other vascular morbidities, including acute myocardial infarction (AMI) and stroke, were underestimated 8,12 . Most importantly, most nationwide cohort studies lack reliable multicentre validation to evaluate the accuracy of diagnosis, social habits and cancer stages 8,12 .…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, despite trastuzumab inducing cardiovascular complications from several different perspectives, previous studies focused only on myocardial dysfunction, such as HF, whereas other vascular morbidities, including acute myocardial infarction (AMI) and stroke, were underestimated. 8 , 12 Most importantly, most nationwide cohort studies lack reliable multicentre validation to evaluate the accuracy of diagnosis, social habits and cancer stages. 8 , 12 Therefore, it is mandatory to evaluate the incidences and clinical characteristics of trastuzumab‐induced cardiotoxicity in Asian women with breast cancer.…”

Section: Introductionmentioning

confidence: 99%

“… 8 , 12 Most importantly, most nationwide cohort studies lack reliable multicentre validation to evaluate the accuracy of diagnosis, social habits and cancer stages. 8 , 12 Therefore, it is mandatory to evaluate the incidences and clinical characteristics of trastuzumab‐induced cardiotoxicity in Asian women with breast cancer. In this study, using the Taiwan national database and a three‐hospital cohort, we aimed to estimate the risk of trastuzumab‐related major adverse cardiac and cerebrovascular event (MACCE) in an Asian population.…”

Section: Introductionmentioning

confidence: 99%

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Risks of trastuzumab‐related cardiotoxicity in breast cancer patients in Taiwan

et al. 2021

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Aims In contrast to Western patients with breast cancer, Asian patients are relatively younger at diagnosis, and most are free from traditional cardiovascular risk factors. Despite trastuzumab‐related major adverse cardiac and cerebrovascular event (MACCE) being reported, its incidence and predictors remain unknown in Taiwan. Methods and results Through a three‐hospital retrospective cohort study, we analysed the incidence of MACCE in 386 breast cancer patients' exposure to trastuzumab from 2010 to 2018. To further reconfirm our findings, in a nationwide study using the Taiwanese National Health Insurance Research Database and National Cancer Registry, we identified 13 502 women diagnosed with breast cancer who received chemotherapy from 2010 to 2015 and found 6751 women who received initial treatment with trastuzumab. After 1:1 propensity score matching with trastuzumab non‐users, the incidence of MACCE was measured with a median follow‐up of 36 months. In the hospital‐based study, among 386 patients receiving trastuzumab, the 5‐year incidences of MACCE and heart failure (HF) were 5.4 and 2.8%, respectively. In the national cohort, the crude incidences of MACCEs and HF were 4.67 and 3.21%, respectively. After adjustment for age and comorbidities, the hazard ratio of MACCE was 1.485 (95% CI 1.246–1.769). Notably, among the endpoints, only the hazard ratio of HF was significantly higher in patients receiving trastuzumab than in nonusers. In the subgroup analysis, except for patients also using taxanes, those receiving trastuzumab had a higher risk of MACCE than non‐users. Conclusions From clinical observations in a nationwide cohort, we found an increased risk of MACCE, especially HF, in patients receiving trastuzumab. Given that its cardiotoxicity is independent of traditional cardiovascular risks, our findings highlight critical concerns regarding the cardiac safety of trastuzumab use.

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Cardiovascular Risk After Adjuvant Trastuzumab in Early Breast Cancer: An Italian Population-Based Cohort Study

Abstract: a,b on behalf of the FABIO working group

Cited by 7 publications

References 30 publications

Cardiac function in women receiving dual anti-Her2 antibodies (trastuzumab and pertuzumab) combined with chemotherapy for breast cancer

Cardiac function in women receiving dual anti-Her2 antibodies (trastuzumab and pertuzumab) combined with chemotherapy for breast cancer

The Value of 320-Slice Spiral Computed Tomography Perfusion Imaging in Staging and Long-Term Dynamic Evaluation of Breast Cancer

Risks of trastuzumab‐related cardiotoxicity in breast cancer patients in Taiwan

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