Trastuzumab-related cardiac toxicity in patients with Her-2 positive early breast cancer: Experience from a regional cancer centre


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Ravi Dandamudi1, D A Jones1, christopher Poole1, r j Grieve1
1university hospitals coventry and warwickshire NHS trust, coventry, United Kingdom

Background

Trastuzumab is recommended as adjuvant treatment by the National Institute for Health and Clinical Excellence (NICE) in women with Her-2 positive early breast cancer (EBC).

Method

Retrospective analysis of 106 women treated with adjuvant Trastuzumab from 2006-2009. We investigated Trastuzumab-related cardiac toxicity and also assessed adherence to NICE guidelines. Congestive heart failure (CHF) was classified according to the New York Heart Association(NYHA) classification and diagnosed independently by a cardiologist.

Results

All patients had baseline assessment of Left Ventricular Ejection Fraction (LVEF), mostly by MUGA scanning. All but 2 patients (98.11%) had a baseline LVEF of >55%. Trastuzumab was commenced in 2 patients who did not meet this criteria following advice from a cardiologist. However, treatment was suspended in both women within 3 months following development of NYHA grade 2 CHF due to precipitation of previously unidentified structural defects/arrhythmias. 1 patient with 3 cardiac risk factors but acceptable baseline LVEF developed NYHA grade 3 CHF following 6 months of treatment. 7/106 (6.6%) women had an asymptomatic drop in LVEF (>10% from baseline or LVEF<50%).Trastuzumab was discontinued in 6 women (5.66%). 100/106 (94.33%) women had previous (neo) adjuvant anthracycline based chemotherapy and none of them received in the presence of 2 or more cardiac risk factors. Age, left sided radiotherapy without cardiac shielding showed no increased risk. While on treatment, maximum LVEF (%) drop from baseline was higher in those with baseline LVEF<60%.

Conclusion

This study highlights the importance of adhering to NICE guidelines in reducing the incidence of Trastuzumab-related cardiac toxicity. Patients with a low baseline LVEF and/pre-existing cardiac anomalies/risk factors were more likely to experience cardiac toxicity.