College of Medicine, Alfaisal University, King Faisal Specialist Hospital & Research Centre, Jeddah, Saudi Arabia.
King Faisal Specialist Hospital & Research Centre, Jeddah, Saudi Arabia.
Womens Health (Lond). 2023 Jan-Dec;19:17455057231166837. doi: 10.1177/17455057231166837.
Chemotherapy regimens containing a combination of anti-Her2 antibodies are effective but can be associated with cardiac toxicity.
We evaluate the outcome with a particular focus on the cardiac function of patients with Her2 over-expressed breast cancer receiving Chemotherapy regimens combined with Trastuzumab and Pertuzumab in routine clinical practice settings.
The initial cohort of patients who started Chemotherapy regimens in combination with Trastuzumab and Pertuzumab before September 2019 in four cancer units were reviewed retrospectively. All patients had regular measurements of left ventricular ejection fraction by Doppler ultrasound.
Sixty-seven patients were identified. Chemotherapy regimens in combination with Trastuzumab and Pertuzumab treatment were administered in the neoadjuvant and palliative settings in 28 (41.8%) and 39 (58.2%) patients, respectively. All patients underwent left ventricular ejection fraction assessment prior to starting Chemotherapy regimens in combination with Trastuzumab and Pertuzumab treatment and at 3 and 6 months later. Subsequently, left ventricular ejection fraction was measured at 9, 12, 15, 18, 21, and 24 months as long as patients are still receiving any of the treatment components. Compared to baseline, the mean left ventricular ejection fraction was not significantly different at any of the subsequent time points (range; decrease by 0.936% to increase by 1.087%: -test value not statistically significant for all comparisons). Trastuzumab and Pertuzumab administration was withheld temporarily for two patients due to clinically suspected cardiac toxicity which was excluded upon further investigations. In the neoadjuvant cohort, 82.3% of patients were relapse free at 3 years. The median progression-free survival was 20 months, and the median overall survival was 41 months in the palliative cohort.
In this cohort describing our limited initial experience, dual anti-Her2 antibodies (Trastuzumab and Pertuzumab) combined with chemotherapy is effective and not associated with significant cardiac toxicity when the left ventricular ejection fraction is measured every 3 months. This may suggest that previous concerns about cardiotoxicity may have been overemphasized. Further studies investigating less frequent left ventricular ejection fraction monitoring may be warranted.
含有抗 Her2 抗体的化疗方案具有疗效，但可能与心脏毒性相关。
我们评估了特定人群的治疗结果，重点关注接受曲妥珠单抗和帕妥珠单抗联合化疗方案的 Her2 过表达乳腺癌患者的心脏功能，这些患者均来自常规临床实践环境。
回顾性分析了在四个癌症中心于 2019 年 9 月前开始接受曲妥珠单抗和帕妥珠单抗联合化疗方案的患者初始队列。所有患者均定期通过多普勒超声检查左心室射血分数。
共确定了 67 例患者。曲妥珠单抗和帕妥珠单抗联合化疗方案分别在新辅助和姑息治疗环境中应用于 28（41.8%）和 39（58.2%）例患者。所有患者在开始曲妥珠单抗和帕妥珠单抗联合化疗方案治疗前以及 3 个月和 6 个月后均进行左心室射血分数评估。随后，只要患者仍在接受任何治疗方案，左心室射血分数将在 9、12、15、18、21 和 24 个月进行测量。与基线相比，在随后的任何时间点，平均左心室射血分数均无显著差异（范围：降低 0.936%至增加 1.087%：-检验值对于所有比较均无统计学意义）。两名患者因临床疑似心脏毒性而暂时停用曲妥珠单抗和帕妥珠单抗，但进一步检查后排除了心脏毒性。在新辅助治疗队列中，82.3%的患者在 3 年时无复发。无进展生存期的中位数为 20 个月，姑息治疗队列的总生存期中位数为 41 个月。
在本队列研究中，我们描述了有限的初步经验，在每 3 个月测量左心室射血分数时，联合化疗的双抗 Her2 抗体（曲妥珠单抗和帕妥珠单抗）是有效的，且不会引起明显的心脏毒性。这可能表明先前对心脏毒性的担忧可能被过分强调了。可能需要进一步研究，以评估较少监测左心室射血分数的频率。
