Department of Medical Oncology and Radiotherapy, Oulu University Hospital, University of Oulu, and MRC Oulu, P.B. 22, 90029, Oulu, Finland.
Finnish Medicines Agency, Helsinki, Finland.
J Cancer Res Clin Oncol. 2018 Aug;144(8):1613-1621. doi: 10.1007/s00432-018-2682-9. Epub 2018 Jun 5.
Cardiotoxicity is the most important side effect of trastuzumab treatment. Heart function monitoring is recommended during the treatment which has led to growing use of resources. The aim of this retrospective study was to determine the frequency and timing of trastuzumab cardiotoxicity and its risk factors in real-world setting.
Single institute, retrospective collection of data on HER2+ breast cancer patients (n = 246) was carried out through a pharmacy search for patients who had received trastuzumab in 2006-2014. Clinical and pathological factors, treatment history, EF measurements, cardiac medications, cardiovascular disease history, cardiac symptoms, and survival data were collected from patient records.
32 patients (13%) had EF decline ≥ 10%, eleven (4.5%) had EF decline ≥ 20% within 1 year after trastuzumab initiation, and trastuzumab was discontinued due to suspected cardiotoxicity in six patients (2.4%). 49 patients (19.9%) experienced symptoms related to cardiotoxicity during therapy, which accumulated among those with EF drop. Underlying cardiovascular diseases and multiple (≥ 2) cardiac medications were related to EF drop (≥ 20%) and trastuzumab discontinuation. Majority of EF drops (≥ 10%) and trastuzumab discontinuations were seen within 6months of trastuzumab initiation and recovery of EF drop to < 10% of the baseline was seen in most cases (62.5%). There was no statistically significant difference in the survival of patients according to EF drop.
Trastuzumab cardiotoxicity seems to accumulate among patients with underlying cardiac conditions. EF monitoring could be targeted to risk groups without compromising of the cardiac health or survival of HER2-positive breast cancer patients.
曲妥珠单抗治疗的最重要的副作用是心脏毒性。建议在治疗期间监测心脏功能，这导致了资源的大量使用。本回顾性研究的目的是确定曲妥珠单抗心脏毒性的频率和时间及其在真实环境中的危险因素。
通过药房搜索，对 2006 年至 2014 年间接受曲妥珠单抗治疗的 HER2+乳腺癌患者（n=246）进行了单中心、回顾性数据收集。从患者病历中收集了临床和病理因素、治疗史、EF 测量值、心脏药物、心血管疾病史、心脏症状和生存数据。
32 名患者（13%）EF 下降≥10%，11 名患者（4.5%）在曲妥珠单抗开始后 1 年内 EF 下降≥20%，6 名患者（2.4%）因疑似心脏毒性而停用曲妥珠单抗。49 名患者（19.9%）在治疗期间出现与心脏毒性相关的症状，这些症状在 EF 下降的患者中累积。基础心血管疾病和多种（≥2 种）心脏药物与 EF 下降（≥20%）和曲妥珠单抗停药有关。大多数 EF 下降（≥10%）和曲妥珠单抗停药发生在曲妥珠单抗开始后 6 个月内，大多数情况下 EF 下降恢复到基线值的<10%（62.5%）。根据 EF 下降，患者的生存无统计学差异。
曲妥珠单抗心脏毒性似乎在有基础心脏疾病的患者中累积。EF 监测可以针对高危人群进行，而不会影响 HER2 阳性乳腺癌患者的心脏健康或生存。
