Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST-IRCCS), via Piero Maroncelli 40, Meldola 47014, Italy.
Heart. 2013 May;99(9):634-9. doi: 10.1136/heartjnl-2012-303151. Epub 2013 Jan 24.
Although adjuvant trastuzumab improves survival in patients with HER2-positive early breast cancer, there is growing concern about the long-term effect of trastuzumab-induced cardiotoxicity (TIC). We retrospectively assessed the incidence of TIC and heart failure (HF) to identify possible risk and protective factors.
Retrospective study.
Institute for Cancer Research and Treatment, Medical Oncology Department.
Consecutive patients who started adjuvant trastuzumab between 2007 and 2010.
Measures TIC was defined as an absolute left ventricular ejection fraction (LVEF) decrease ≥ 15 points from baseline or a LVEF<50%. Logistic regression was used to estimate OR and their 95% CI in order to evaluate the risk of TIC, considering potential cardiac risk factors (hypertension, hypercholesterolaemia, diabetes mellitus, smoke, cardiac ischaemia and previous chest radiotherapy) and protective factors (β-blockers, ACE inhibitors and/or angiotensin receptor blockers).
Among 179 patients, 78 cases of TIC (44%, 95% CI 37% to 51%) and four cases of HF (2%, 95% CI 0% to 4%) were reported. 14 patients stopped trastuzumab as a result of TIC. None of the cardiac risk factors or concomitant cardiovascular medications altered the risk of TIC. A previous cumulative dose >240 mg/m(2) of doxorubicin or >500 mg/m(2) of epirubicin increased the risk of TIC compared with lower doses (OR 3.07; 95% CI 1.29 to 7.27, p=0.0011).
TIC is a frequent, albeit generally mild, adverse event in clinical practice. Further studies are warranted to better define the risk of and protective factors for TIC.
曲妥珠单抗辅助治疗可提高 HER2 阳性早期乳腺癌患者的生存率，但人们对曲妥珠单抗诱导的心脏毒性（TIC）的长期影响越来越关注。我们回顾性评估了 TIC 和心力衰竭（HF）的发生率，以确定可能的风险和保护因素。
回顾性研究。
癌症研究所和治疗中心，医学肿瘤学系。
2007 年至 2010 年间开始接受辅助曲妥珠单抗治疗的连续患者。
TIC 的定义为与基线相比绝对左心室射血分数（LVEF）下降≥15 个点或 LVEF<50%。使用逻辑回归估计 OR 及其 95%CI，以评估 TIC 的风险，考虑潜在的心脏危险因素（高血压、高胆固醇血症、糖尿病、吸烟、心脏缺血和先前的胸部放疗）和保护因素（β受体阻滞剂、ACE 抑制剂和/或血管紧张素受体阻滞剂）。
在 179 例患者中，报告了 78 例 TIC（44%，95%CI 37%至 51%）和 4 例 HF（2%，95%CI 0%至 4%）。14 例患者因 TIC 停止使用曲妥珠单抗。心脏危险因素或同时使用心血管药物均未改变 TIC 的风险。与低剂量相比，阿霉素累积剂量>240mg/m2或表阿霉素累积剂量>500mg/m2 增加 TIC 的风险（OR 3.07；95%CI 1.29 至 7.27，p=0.0011）。
TIC 是临床实践中一种常见但通常较轻的不良事件。需要进一步研究以更好地确定 TIC 的风险和保护因素。
