Management of cardiac health in trastuzumab-treated patients with breast cancer: updated United Kingdom National Cancer Research Institute recommendations for monitoring

Abstract

More women are living with and surviving breast cancer, because of improvements in breast cancer care. Trastuzumab (Herceptin®▾) has significantly improved outcomes for women with HER2-positive tumours. Concerns about the cardiac effects of trastuzumab (which fundamentally differ from the permanent myocyte loss associated with anthracyclines) led to the development of cardiac guidelines for adjuvant trials, which are used to monitor patient safety in clinical practice. Clinical experience has shown that the trial protocols are not truly applicable to the breast cancer population as a whole, and exclude some women from receiving trastuzumab, even though they might benefit from treatment without long-term adverse cardiac sequelae. Consequently, five oncologists who recruited patients to trastuzumab trials, some cardiologists with whom they work, and a cardiovascular lead general practitioner reviewed the current cardiac guidelines in the light of recent safety data and their experience with adjuvant trastuzumab. The group devised recommendations that promote proactive pharmacological management of cardiac function in trastuzumab-treated patients, and that apply to all patients who are likely to receive standard cytotoxic chemotherapy. Key recommendations include: a monitoring schedule that assesses baseline and on-treatment cardiac function and potentially reduces the overall number of assessments required; intervention strategies with cardiovascular medication to improve cardiac status before, during, and after treatment; simplified rules for starting, interrupting and discontinuing trastuzumab; and a multidisciplinary approach to breast cancer care.

2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure

“…Do najlepiej poznanych zalicza się antracykliny (np. doksorubicyna), trastuzumab oraz inhibitory kinazy tyrozynowej [397,422]. W przeprowadzonym niedawno przeglądzie systematycznym Cochrane wykazano potencjalne działania kardioprotekcyjne deksrazoksanu u pacjentów przyjmujących antracykliny [423].…”

“…W przeprowadzonym niedawno przeglądzie systematycznym Cochrane wykazano potencjalne działania kardioprotekcyjne deksrazoksanu u pacjentów przyjmujących antracykliny [423]. U chorych otrzymujących kardiotoksyczne chemioterapeutyki ważna jest ocena LVEF, połączona z, o ile jest dostępna, oceną odkształcenia miokardium przed i po zakończeniu terapii, co szczegółowo omówiono w innym miejscu [397,422]. Opracowano również specjalną skalę ryzyka rozwoju HF u kobiet z rakiem piersi w trakcie terapii trastuzumabem, która potencjalnie może być pomocna.…”

Reversible cardiotoxicity in a 54-year-old woman treated with trastuzumab

“…New diagnosis resources and more effective therapy schedules have contributed to increase the survival of patients with more aggressive breast cancer that over-expresses or amplifi es the HER2 gene [1][2][3][4] . Nevertheless, adverse effects of chemotherapy (CT) agents, including cardiotoxicity, have been more often observed and this can negatively affect both quality of life and outcome of patients from this group 1,3,5,6 . Trastuzumab (a monoclonal antibody targeting the HER2 gene) and paclitaxel (an antimicrotubule agent) have been employed with success to treat HER2 positive breast cancer [1][2][3]5 .…”

“…Nevertheless, adverse effects of chemotherapy (CT) agents, including cardiotoxicity, have been more often observed and this can negatively affect both quality of life and outcome of patients from this group 1,3,5,6 . Trastuzumab (a monoclonal antibody targeting the HER2 gene) and paclitaxel (an antimicrotubule agent) have been employed with success to treat HER2 positive breast cancer [1][2][3]5 . The incidence of cardiac adverse events associated with isolated use of trastuzumab ranges from 2 to 4% 1,3,5,7 ; and may increase up to 16% with previous use of anthracycline and/or cyclophosphamide 1,[3][4][5][6][7] .…”

“…Trastuzumab (a monoclonal antibody targeting the HER2 gene) and paclitaxel (an antimicrotubule agent) have been employed with success to treat HER2 positive breast cancer [1][2][3]5 . The incidence of cardiac adverse events associated with isolated use of trastuzumab ranges from 2 to 4% 1,3,5,7 ; and may increase up to 16% with previous use of anthracycline and/or cyclophosphamide 1,[3][4][5][6][7] . Trastuzumab has been administered in combination with placlitaxel to treat women who have not previously received CT for metastatic breast cancer 8 .…”