2020
DOI: 10.1001/jamacardio.2019.5586
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Long-term Cardiopulmonary Consequences of Treatment-Induced Cardiotoxicity in Survivors of ERBB2-Positive Breast Cancer

Abstract: IMPORTANCE Trastuzumab improves outcomes in patients with ERBB2-positive (formerly HER2) breast cancer but is associated with treatment-induced cardiotoxicity, most commonly manifest by an asymptomatic decline in left ventricular ejection fraction (LVEF). Little is known to date regarding the long-term effects of treatment-induced cardiotoxicity on cardiopulmonary function in patients who survive trastuzumab-treated breast cancer.OBJECTIVE To determine whether treatment-induced cardiotoxicity recovers or is as… Show more

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Cited by 52 publications
(34 citation statements)
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“…HER2-targeted therapy has dramatically improved the outcome of patients with HER2-positive breast cancer, but such therapy also carries a risk for cardiotoxicity. 13 Whether the shift in HER2-status assignment will significantly alter the overall rates of patient responsiveness to HER2-targeted therapy remains to be determined.…”
Section: Resultsmentioning
confidence: 99%
“…HER2-targeted therapy has dramatically improved the outcome of patients with HER2-positive breast cancer, but such therapy also carries a risk for cardiotoxicity. 13 Whether the shift in HER2-status assignment will significantly alter the overall rates of patient responsiveness to HER2-targeted therapy remains to be determined.…”
Section: Resultsmentioning
confidence: 99%
“…Further, a 31% impairment in cardiorespiratory fitness (CRF), as measured by the peak/maximal oxygen consumption (VO 2max ), has been observed in women with BC undergoing adjuvant chemotherapy [ 12 ]. This is a concern, given that emerging evidence suggests that CRF is a significant prognostic marker, with data indicating that a poor VO 2max is associated with a poorer quality of life, treatment-induced cardiotoxicity, and an increased risk of cancer-related mortality [ 13 , 14 , 15 , 16 ].…”
Section: Introductionmentioning
confidence: 99%
“…Asymptomatic decline in LVEF is the most common manifestation of cardiotoxicity during trastuzumab and can lead to premature interruption or discontinuation of therapy [5]. Although often considered reversible after treatment discontinuation (Type II cardiotoxicity) [5], Yu et al [52] verified that patients with versus without history of trastuzumab-related cardiotoxicity presented lower mean values of resting LVEF (56.9 ± 5.2% vs. 62.4 ± 4%; p < 0.001), GLS (−17.8 ± 2.2% vs. −19.8 ± 2.2%; p < 0.001) and VO 2 peak (22.9 ± 4.4 mL/kg/min vs. 27 ± 5.3 mL/kg/min; p < 0.001) after a mean seven-year follow-up. These novel findings suggest that the development of cardiotoxicity during trastuzumab may lead to a persistent long-term impairment on cardiac function, which extends beyond the heart, affecting the cardiorespiratory capacity, emphasizing the need to implement holistic strategies for support cardiovascular health.…”
Section: Discussionmentioning
confidence: 99%