Division of Cardiology, Peter Munk Cardiac Center, Ted Rogers Program in Cardiotoxicity Prevention, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Division of Cardiology, Peter Munk Cardiac Center, Ted Rogers Program in Cardiotoxicity Prevention, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Division of Cardiology, Women's College Hospital, Toronto, Ontario, Canada.
Am J Cardiol. 2020 Apr 15;125(8):1270-1275. doi: 10.1016/j.amjcard.2020.01.029. Epub 2020 Jan 27.
Prolonged trastuzumab therapy is the standard of care for women with metastatic HER2 positive (HER2+) breast cancer. There are limited data on the incidence of cardiotoxicity, its treatment implication, and cardiac care in these patients. We retrospectively identified consecutive women who received >12 months of trastuzumab treatment at Princess Margaret Cancer Centre (Toronto, ON) from 2007 to 2012 for metastatic HER2 positive breast cancer and followed them until death or August 2018. Patients were included if a pretherapy multigated acquisition scan and ≥2 subsequent follow-up scans were available. The Cardiac Review and Evaluation Committee Criteria were used to identify cardiotoxicity. Baseline characteristics and outcomes (final left ventricular ejection fraction, change in LVEF, trastuzumab interruption) were compared in patients with and without cardiotoxicity. Cardiac care and treatment received were recorded. Sixty patients (mean age 52 ± 10.4 years) were included. The median trastuzumab exposure was 37 cycles (interquartile range 23 to 56) over 28 months (interquartile range 19 to 49) and 48% received previous anthracycline therapy. The cumulative incidence of cardiotoxicity was 35% (95% CI 23 to 48) at 3 years. Patients who developed cardiotoxicity were more likely to receive third-line cancer treatments and had lower final LVEF than patients without (54.9% ± 6.3% vs 64% ± 4.9%, p <0.001). Of the 23 patients with cardiotoxicity, 10 (43%) had trastuzumab interrupted for at least 1 cycle, only 7 (30%) patients were seen by a cardiologist and 4 (17%) received cardiac medications. In conclusion, patients with metastatic breast cancer receiving prolonged trastuzumab therapy appear to have high rates of cardiotoxicity. This was associated with high rates of trastuzumab interruption, but low rates of cardiology referral and cardiac treatment, reflecting a potential cardiac care gap.
曲妥珠单抗的延长治疗是转移性 HER2 阳性（HER2+）乳腺癌患者的标准治疗方法。关于这些患者的心毒性发生率、其治疗意义和心脏护理的相关数据有限。我们回顾性地确定了 2007 年至 2012 年期间在玛格丽特公主癌症中心（多伦多，ON）接受曲妥珠单抗治疗>12 个月的转移性 HER2 阳性乳腺癌的连续女性患者，并对其进行随访直至死亡或 2018 年 8 月。如果患者有治疗前多门控采集扫描和≥2 次后续随访扫描，则将其纳入研究。使用心脏审查和评估委员会标准来确定心毒性。比较有心毒性和无心毒性患者的基线特征和结局（最终左心室射血分数、LVEF 变化、曲妥珠单抗中断）。记录心脏护理和治疗措施。60 名患者（平均年龄 52 ± 10.4 岁）被纳入研究。曲妥珠单抗中位暴露时间为 37 个周期（23 至 56 个周期），28 个月（19 至 49 个周期），48%的患者接受过蒽环类药物治疗。3 年时心毒性的累积发生率为 35%（95%CI 23%至 48%）。发生心毒性的患者更有可能接受三线癌症治疗，且最终 LVEF 低于无心毒性的患者（54.9% ± 6.3% vs 64% ± 4.9%，p<0.001）。在 23 例有心毒性的患者中，有 10 例（43%）至少中断 1 个周期的曲妥珠单抗治疗，仅有 7 例（30%）患者接受了心脏病专家的诊治，4 例（17%）患者接受了心脏药物治疗。总之，接受曲妥珠单抗延长治疗的转移性乳腺癌患者似乎有心毒性发生率较高的情况。这与曲妥珠单抗中断率较高相关，但心脏病学转诊和心脏治疗率较低，反映出潜在的心脏护理差距。
