Ürun Y, Utkan G, Yalcin B, Akbulut H, Onur H, Oztuna D G, Şenler F C, Demirkazık A, İçli F
Department of Medical Oncology,Gaziantep Dr. Ersin Arslan State Hospital, Gaziantep 27310, Turkey.
Department of Medical Oncology, Ankara University School of Medicine, Ankara 06590, Turkey.
Exp Oncol. 2015 Mar;37(1):53-7.
Identification of patient with increased risk of cardiotoxicity would allow not only prevention and early diagnosis of chemotherapy related cardiotoxicity but also administration of optimal dose and duration of chemotherapy.
Fifty-two women with HER2(+) breast cancer treated with trastuzumab were included in this study. Patients were prospectively followed with routine cardiac evaluation. Before and after administration of trastuzumab blood samples for NT-proBNP were also taken.
The median age was 48.5 year (range: 26-74). Hypertension and obesity were two most common co-morbidities. The median duration application of trastuzumab was 52 weeks. During median 14.5 (3-33) months follow-up cardiac adverse events occurred in 5 (9.6%) patients and 2 out of 5 was grade III-IV heart failure. Both patients had preserved left ventricular ejection fraction and no symptom of heart failure before trastuzumab but older than 65 years old and had diabetes mellitus and obesity. High level of NT-proBNP (> 300 ng/ml) was observed in both patients and heart failure recovery was not observed. There was statistically significant difference regarding body mass index (p = 0.004) and diabetes mellitus (p = 0.002) between patients with and without cardiotoxicity.
Although, cardiac biomarkers still cannot replace routine cardiac monitoring, natriuretic peptides may provide additional tool for detection of patients with high risk of cardiotoxicity and early detection of cardiotoxicity.
识别具有心脏毒性风险增加的患者不仅有助于预防和早期诊断化疗相关心脏毒性，还能优化化疗药物的剂量和疗程。
本研究纳入了52例接受曲妥珠单抗治疗的HER2(+)乳腺癌女性患者。对患者进行前瞻性的常规心脏评估。在给予曲妥珠单抗前后，还采集了用于检测N末端脑钠肽前体（NT-proBNP）的血样。
患者的中位年龄为48.5岁（范围：26 - 74岁）。高血压和肥胖是最常见的两种合并症。曲妥珠单抗的中位使用时间为52周。在中位14.5（3 - 33）个月的随访期间，5例（9.6%）患者发生了心脏不良事件，其中2例为III - IV级心力衰竭。这两名患者在使用曲妥珠单抗前左心室射血分数正常且无心力衰竭症状，但年龄均大于65岁，患有糖尿病和肥胖症。两名患者均观察到高水平的NT-proBNP（> 300 ng/ml），且心力衰竭未恢复。发生心脏毒性和未发生心脏毒性的患者在体重指数（p = 0.004）和糖尿病（p = 0.002）方面存在统计学显著差异。
尽管心脏生物标志物仍不能取代常规心脏监测，但利钠肽可能为检测具有高心脏毒性风险的患者及早期发现心脏毒性提供额外的手段。
