Rushton Moira, Kappel Coralea, Lima Isac, Tuna Meltem, Pritchard Kathleen, Hawken Steven, Dent Susan
The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada.
Department of Medicine, McMaster University, Hamilton, ON, Canada.
Front Cardiovasc Med. 2022 May 19;9:850674. doi: 10.3389/fcvm.2022.850674. eCollection 2022.
Trastuzumab has improved patient outcomes in HER2 + breast cancer (BC) but carries a risk of cardiotoxicity. Routine cardiac imaging is recommended for advanced breast cancer (aBC) patients during trastuzumab treatment despite a lack of evidence that this improves patient outcomes. This study was conducted to understand predictive factors for cardiac events and determine the impact of cardiovascular monitoring in aBC.
This retrospective population-based cohort study included aBC patients treated with trastuzumab (all lines), in Ontario, Canada from 2007 to 2017. The overall cohort was divided into two groups; those who developed a cardiac event (CE) vs. those who did not. Patients with pre-existing heart disease were excluded. Logistic regression was performed to identify patient characteristics associated with an increased risk of CE.
Of 2,284 patients with HER2 + aBC treated with trastuzumab, 167 (7.3%) developed a CE. Median age at first dose of trastuzumab was 57 (IQR 49-66); 61 (IQR 51-70) for patients with a CE. Median number of cycles was 16 (IQR 7-32); 21 (IQR 8-45) for patients with a CE ( < 0.01). Twelve (0.5%) patients died of cardiac causes; all had a prior CE. Increased risk of CEs was associated with age > 60 (OR 5.21, 95% CI 1.83-14.84, = 0.05) and higher number cycles of trastuzumab (OR 1.01; 95% CI 1-101, = 0.028).
This is the first population-based study to report on CEs and cardiac monitoring in HER2 + aBC patients during trastuzumab-based therapy. Older age and longer treatment with trastuzumab were associated with an increased risk of a CE.
曲妥珠单抗改善了HER2阳性乳腺癌（BC）患者的预后，但存在心脏毒性风险。尽管缺乏证据表明常规心脏成像可改善患者预后，但仍建议对晚期乳腺癌（aBC）患者在曲妥珠单抗治疗期间进行常规心脏成像。本研究旨在了解心脏事件的预测因素，并确定心血管监测对aBC的影响。
这项基于人群的回顾性队列研究纳入了2007年至2017年在加拿大安大略省接受曲妥珠单抗（所有疗程）治疗的aBC患者。整个队列分为两组；发生心脏事件（CE）的患者与未发生心脏事件的患者。排除已有心脏病的患者。进行逻辑回归分析以确定与CE风险增加相关的患者特征。
在2284例接受曲妥珠单抗治疗的HER2阳性aBC患者中，167例（7.3%）发生了CE。首次使用曲妥珠单抗时的中位年龄为57岁（四分位间距49 - 66岁）；发生CE的患者为61岁（四分位间距51 - 70岁）。中位疗程数为16个（四分位间距7 - 32个）；发生CE的患者为21个（四分位间距8 - 45个）（P < 0.01）。12例（0.5%）患者死于心脏原因；均曾发生过CE。CE风险增加与年龄>60岁（比值比5.21，95%置信区间1.83 - 14.84，P = 0.05）和曲妥珠单抗疗程数较多（比值比1.01；95%置信区间1.001 - 1.019，P = 0.028）相关。
这是第一项基于人群的研究，报告了HER2阳性aBC患者在基于曲妥珠单抗治疗期间的CE和心脏监测情况。年龄较大和曲妥珠单抗治疗时间较长与CE风险增加相关。
