Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Jul 26, 2022; 14(7): 403-410
Published online Jul 26, 2022. doi: 10.4330/wjc.v14.i7.403
Is there a window of opportunity to optimize trastuzumab cardiac monitoring?
Bruno Henrique Rala de Paula, Maria Eduarda Teixeira Ferro Costa, Carlos Augusto Moreira de Sousa, José Bines
Bruno Henrique Rala de Paula, Sarah Cannon Research Institute, London W1G 6AD, United Kingdom
Maria Eduarda Teixeira Ferro Costa, Department of Cardiology, Hospital do Câncer III-Instituto Nacional de Câncer, Rio de Janeiro 20560-121, Brazil
Carlos Augusto Moreira de Sousa, Departamento de Tecnologias da Informação e Educação em Saúde (DTIES), da Faculdade de Ciências Médicas (FCM), na Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro 20550-170, Brazil
José Bines, Department of Medical Oncology, Instituto Nacional de Câncer, Rio de Janeiro 20560-121, Brazil
Author contributions: Rala de Paula BH, Costa METF and Bines J contributed to data collection; Rala de Paula BH, de Sousa CAM and Bines J were in charge of statistical analysis; All authors participated in the study plan, paper writing and reviewing and approved the final manuscript.
Institutional review board statement: This work was approved by the Instituto Nacional de Cancer under the number 2.789.267.
Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.
Data sharing statement: Data can be shared under the regulations of Instituto Nacional de Cancer.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bruno Henrique Rala de Paula, MD, MSc, Research Fellow, Sarah Cannon Research Institute, 93 Harley Street Central, London W1G 6AD, United Kingdom. brunobhrp@hotmail.com
Received: December 23, 2021
Peer-review started: December 23, 2021
First decision: February 15, 2022
Revised: March 29, 2022
Accepted: June 17, 2022
Article in press: June 17, 2022
Published online: July 26, 2022
Abstract
BACKGROUND

It remains unclear whether the current arbitrary screening recommendations of trastuzumab-related cardiotoxicity provides an adequate balance between preventing heart damage and curtailing a curative treatment.

AIM

To determine the incidence rate and consequences of trastuzumab-induced cardiotoxicity as adjuvant treatment in a real-world scenario.

METHODS

We present a retrospective analysis of cardiac function measured by echocardiogram at baseline and every 3 mo during trastuzumab treatment. Cardiotoxicity was defined as a drop in left ventricular ejection fraction (LVEF) ≥ 10% from baseline and/or any drop < 50%.

RESULTS

Between January 2011 and December 2014, 407 patients were selected. Most (93.6%) were treated with an anthracycline followed by a taxane-based regimen and trastuzumab for 12 mo. Forty patients (9.8%) had cardiotoxicity. None of them were symptomatic, and 28 (72.5%) completely recovered LVEF. Cardiotoxicity happened early as shown by LVEF measured on echocardiogram 2 to 4 as compared to 5 to 7 (odds ratio = 2.47, 95% confidence interval: 1.09, 5.63, P = 0.024). There were 54 deaths (13.3%) during the 70-mo follow-up period; 1 (0.2%) was attributed to late cardiotoxicity (4 years after treatment). The absence of symptomatic cardiotoxicity during trastuzumab treatment and moreover the early occurrence on the treatment period may translate into a strategy to evaluate less frequently.

CONCLUSION

We observed a 10% rate of asymptomatic cardiotoxicity, which mirrors the results from the large adjuvant trials. Despite being transient, an LVEF drop led to frequent treatment delays and interruptions. It remains unclear whether LVEF decline is predictive of late cardiotoxicity, and treatment efficacy is compromised.

Keywords: Cardiac toxicity, Ventricular Dysfunction, Heart failure, Trastuzumab, Breast cancer

Core Tip: It remains unclear whether the current arbitrary screening recommendations for trastuzumab-related cardiotoxicity in early-stage HER2-positive breast cancer provides an adequate balance between preventing heart damage and curtailing a curative treatment. Real world data showed that despite a low rate of mainly early, asymptomatic and transient cardiotoxicity, treatment delays and interruptions occur due to these findings. The study results suggest optimization of cardiac monitoring after an initial period without a decrease in cardiac function.