Sato Akihiko, Yoshihisa Akiomi, Miyata-Tatsumi Makiko, Oikawa Masayoshi, Kobayashi Atsushi, Ishida Takafumi, Ohtake Tohru, Takeishi Yasuchika
Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan.
Department of Breast Surgery, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan.
Mol Clin Oncol. 2019 Jan;10(1):37-42. doi: 10.3892/mco.2018.1764. Epub 2018 Nov 13.
Although the use of trastuzumab has been reported to improve overall survival in patients with HER2-positive breast cancer, there is increasing concern about the adverse effects of trastuzumab-induced cardiotoxicity (TIC). The aim of the present study was to investigate the predictor of TIC and to consider appropriate management for such patients. The present study breast cancer 119 patients with breast cancer who had been treated with trastuzumab. Patients were referred to our department for cardiac function screening. The patients' baseline characteristics, echocardiographic data, presence of trastuzumab-induced cardiotoxicity (TIC) and all-cause mortality were investigated. TIC was defined as a manifestation of overt heart failure or ≥10% reduction of left ventricular ejection fraction (LVEF) from baseline to an LVEF <55% in asymptomatic patients. During the follow-up period (mean, 1,410 days), symptomatic heart failure occurred in 2 out of 119 patients (1.6%), 11 patients (9.2%) had asymptomatic impairment of cardiac function that was ameliorated by discontinuing trastuzumab and 20 patients (16.8%) succumbed to cancer-associated fatality. In the logistic regression analysis, only the presence of valvular heart disease at the baseline was indicated to be a predictor of TIC. There was no other predictor for TIC, including baseline characteristics, other therapies and echocardiographic parameters. In addition, impairment of cardiac function was ameliorated by discontinuing trastuzumab. TIC occurred in ~10% of the patients treated with trastuzumab. Only the presence of valvular heart disease seems to be associated with occurrence of TIC, with no other specific predictor of TIC demonstrated in the present study. The present data suggests the importance of regular monitoring of cardiac function, and that presence of valvular heart disease may be a possible predictor of TIC.
尽管据报道使用曲妥珠单抗可提高HER2阳性乳腺癌患者的总生存率，但人们对曲妥珠单抗诱导的心脏毒性（TIC）的不良反应越来越关注。本研究的目的是调查TIC的预测因素，并考虑对此类患者的适当管理。本研究纳入了119例接受曲妥珠单抗治疗的乳腺癌患者。患者被转诊至我科进行心脏功能筛查。调查了患者的基线特征、超声心动图数据、曲妥珠单抗诱导的心脏毒性（TIC）的存在情况以及全因死亡率。TIC被定义为明显心力衰竭的表现，或无症状患者的左心室射血分数（LVEF）从基线降低≥10%至LVEF<55%。在随访期间（平均1410天），119例患者中有2例（1.6%）出现症状性心力衰竭，11例患者（9.2%）有无症状性心脏功能损害，通过停用曲妥珠单抗得到改善，20例患者（16.8%）死于癌症相关死亡。在逻辑回归分析中，仅基线时存在瓣膜性心脏病被表明是TIC的预测因素。没有其他TIC的预测因素，包括基线特征、其他治疗方法和超声心动图参数。此外，停用曲妥珠单抗可改善心脏功能损害。接受曲妥珠单抗治疗的患者中约10%发生TIC。本研究中似乎只有瓣膜性心脏病的存在与TIC的发生相关，未显示其他TIC的特异性预测因素。本数据表明定期监测心脏功能的重要性，并且瓣膜性心脏病的存在可能是TIC的一个可能预测因素。
