Rala de Paula BH, Costa METF, de Sousa CAM, Bines J. Is there a window of opportunity to optimize trastuzumab cardiac monitoring? World J Cardiol 2022; 14(7): 403-410 [PMID: 36161060 DOI: 10.4330/wjc.v14.i7.403]
Corresponding Author of This Article
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
Research Domain of This Article
Oncology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
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
ARTICLE HIGHLIGHTS
Research 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.
Research motivation
There is an urgent need to optimize monitoring of cardiotoxicity.
Research objectives
This study aimed to determine the incidence rate and consequences of trastuzumab-induced cardiotoxicity as adjuvant treatment in a real-world scenario.
Research methods
A retrospective chart review was performed using patient medical files during 5 years at a single institution in Brazil. Patients had tissue confirmation of HER2-positive breast cancer, stage I to III, treatment with chemotherapy combined with and followed by trastuzumab. Exclusion criteria included loss to follow-up in less than 3 mo after treatment initiation.
Research results
Forty patients (9.8%) had cardiotoxicity (out of 407 included). None of them were symptomatic, and 28 (72.5%) completely recovered left ventricular ejection fraction. Cardiotoxicity happened early as shown by left ventricular ejection fraction 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).
Research conclusions
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 frequent cardiac monitoring.
Research perspectives
This data alongside similar studies in the literature warrants a prospective evaluation of a de-escalation of cardiotoxicity monitoring in a selected population.
