Role of hypertension on new onset congestive heart failure in patients receiving trastuzumab therapy for breast cancer

Russo, Giulia; Cioffi, Giovanni; Gori, Stefania; Tuccia, Fausto; Boccardi, L; Khoury, Georgette; Lestuzzi, Chiara; Maurea, Nicola; Oliva, Stefano; Faggiano, Pompilio; Tarantini, Luigi

doi:10.2459/jcm.0b013e328365afb5

Cited by 24 publications

(13 citation statements)

References 26 publications

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“…15 Arterial hypertension has previously been identified as one of the main factors for ADRC. 16,17 The rate of previous cardiac disease was 6.3%, another finding, which confirms previous investigations. 16 The increasing number of the COT study population might influence the determinants of ADRC because of factors such as age, previous cardiac irradiation, and especially coronary artery disease.…”

Section: Discussionsupporting

confidence: 87%

Protocol update and preliminary results of EACVI/HFA Cardiac Oncology Toxicity (COT) Registry of the European Society of Cardiology

et al. 2017

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AimsEuropean Association of Cardiovascular Imaging/Heart Failure Association Cardiac Oncology Toxicity Registry was launched in October 2014 as a European Society of Cardiology multicentre registry of breast cancer patients referred to imaging laboratories for routine surveillance, suspected, or confirmed anticancer drug‐related cardiotoxicity (ADRC). After a pilot phase (1 year recruitment and 1 year follow‐up), some changes have been made to the protocol (version 1.0) and electronic case report form.Methods and resultsMain changes of the version 2.0 concerned exclusion criteria, registry duration, and clarification of the population characteristics. Breast cancer radiotherapy has been removed as an exclusion criterion, which involves now only history of a pre‐chemotherapy left ventricular dysfunction. The period for long‐term registry recruitment has been reduced (December 2017), but the target study population was extended to 3000 patients. The characteristics of the population are now better defined: patients seen in an imaging lab, which will include patients undergoing chemotherapy with associated targeted therapy or no targeted therapy, at increased risk of ADRC. In total, 1294 breast cancer patients have been enrolled, and 783 case report forms locked from October 2014 to November 2016. Of these, 481 (61.4%) were seen at first evaluation and 302 (38.6%) while on oncologic treatment with anticancer drugs. Fifty‐two patients (17.2%) were not in targeted therapies, 191 (63.3%) were ongoing targeted therapy, and 59 (19.5%) had completed it. Twenty‐three (2.9%) patients had a suspected diagnosis and 35 (4.5%) a confirmed diagnosis of ADRC. Arterial hypertension was the most prevalent cardiovascular risk factor (29.2%) followed by diabetes (6.1%). Previous history of heart failure accounted for 0.5%, whereas previous cardiac disease was identified in 6.3% of population.ConclusionThe changes of the original protocol of the COT Registry and first update allow a first glance to the panorama of cardiovascular characteristics of breast cancer patients enrolled.

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Section: Discussionsupporting

confidence: 87%

Protocol update and preliminary results of EACVI/HFA Cardiac Oncology Toxicity (COT) Registry of the European Society of Cardiology

et al. 2017

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“…(61) The decrease in LV ejection fraction by 2D echocardiography in these patients may not be as profound as once thought and usually does not decease to <50%. (61) Similar to the cardiac troponin study, heart failure (overall incidence 3%) was most commonly (in 44% of the cases) observed in the first 3 months of trastuzumab treatment with decreasing frequency thereafter (25%, 19%, and 12% at 3–6, 6–9, and 9–12 months, respectively). Of further note, despite the development of heart failure, trastuzumab was continued in nearly one third of these patients and most intriguingly with partial recovery in LVEF thereafter; no other adverse events were encountered.…”

Section: Cardiotoxicitymentioning

confidence: 90%

“…Of further note, despite the development of heart failure, trastuzumab was continued in nearly one third of these patients and most intriguingly with partial recovery in LVEF thereafter; no other adverse events were encountered. (61)…”

Section: Cardiotoxicitymentioning

confidence: 99%

An update on cardio-oncology

Herrmann

Lerman

2014

Trends in Cardiovascular Medicine

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Over the past decades there have been great advancements in the survival outcome of patients with cancer. As a consequence, treatment regimens are being extended to patient populations, which would not have qualified in the past based on co-morbidities and age. Furthermore, the anti-cancer regimens, which have been and are being used, can cause considerable morbidity and even mortality. In fact, new drugs such as tyrosine kinase inhibitors have yielded unanticipated side effects in frequency and severity. The cardiovascular disease spectrum is an important element in all of these. In order to optimize the outcome of cancer patients with cardiovascular diseases existing prior to cancer treatment or developing as a consequence of it, a new discipline called “cardio-oncology” has evolved over the past few years. Herein we review the latest developments in this field including cardiotoxicities, vascular toxicities, and arrhythmias. This field is taking on more shape as cardiologists, oncologists, and hematologists are forming alliances, programs, and clinics, supported by the development of expert consensus statements on best management approaches and care of the cancer patient with cardiovascular diseases.

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“…It is possible that a higher proportion of our younger patients received anthracycline-containing therapy, which may worsen cardiac toxicity (76.2% versus 65.5%, p = 0.021). Russo et al [ 21 ] found that patients with hypertension had a relatively higher incidence of trastuzumab-related CHF. They also found that onset of CHF predominantly occurred in the first 6 months of the treatment, which was similar to the findings from our group (median onset of cardiac events 4.54 months; Fig 2A ).…”

Section: Discussionmentioning

confidence: 99%

The Clinical Efficacy and Cardiotoxicity of Fixed-Dose Monthly Trastuzumab in HER2-Positive Breast Cancer: A Single Institutional Analysis

Huang

Tsai

et al. 2016

PLoS ONE

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ObjectiveTrastuzumab-containing treatment regimens have been shown to improve survival outcomes in HER2-positive breast cancer (BC). It is much easier to infuse a fixed one-vial dose to every patient on a regular schedule in the general clinical setting. The aims of this study were evaluating the efficacy of a 440 mg fixed-dose of trastuzumab administered on a monthly infusion schedule, and the risk factors for cardiac events.Patients and methodsWe retrospectively reviewed data from 300 HER2-positive BC patients in our institute: 208 were early-stage BC patients undergoing adjuvant trastuzumab treatment, and 92 were metastatic BC patients treated with trastuzumab infusions until disease progression. There were 181 patients receiving regular trastuzumab infusions every 3 weeks (Q3W; 8 mg/kg loading dose followed by 6 mg/kg every 3 weeks), and the other 119 patients were treated monthly with a fixed 440 mg dose (QM; fixed 440 mg every 4 weeks).ResultsThe medians of progression-free survival (PFS) and overall survival (OS) in the adjuvant setting were not reached in both treatment groups. In the metastatic setting, there was no significant difference between groups in PFS or OS. The median time to significant cardiovascular (CV) dysfunction was 4.54 months. The incidence of congestive heart failure requiring medication in our cohort was 3.4%.ConclusionIn our study, we found that fixed-dose monthly trastuzumab was feasible and effective. In addition, the CV risk was not higher with the fixed-dose protocol. This treatment modality could lower the cost and was easier to implement in clinical practice. Larger prospective randomized studies with longer-term follow up are needed to confirm our results.

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Role of hypertension on new onset congestive heart failure in patients receiving trastuzumab therapy for breast cancer

Abstract: New onset CHF occurs seldom in HER2-positive women with EBC, prevalently in the first 6 months of therapy. CHF is associated with a significant reduction in LVEF and is predicted by a history of hypertension.

Cited by 24 publications

References 26 publications

Protocol update and preliminary results of EACVI/HFA Cardiac Oncology Toxicity (COT) Registry of the European Society of Cardiology

Protocol update and preliminary results of EACVI/HFA Cardiac Oncology Toxicity (COT) Registry of the European Society of Cardiology

An update on cardio-oncology

The Clinical Efficacy and Cardiotoxicity of Fixed-Dose Monthly Trastuzumab in HER2-Positive Breast Cancer: A Single Institutional Analysis

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