Simultaneous hemodynamic and serological cardiotoxicity monitoring during immunotherapy with trastuzumab.
BACKGROUND
Immunotherapy with trastuzumab (Herceptin), a selective HER-2(ErbB2)-antibody, is associated with a certain degree of cardiotoxicity. This study sought to evaluate the immediate hemodynamic response to trastuzumab with real-time CW-Doppler depending on the level of nt-pro-BNP (brain natriuretic peptide) as a possible marker of cardiotoxicity.


METHODS
48 patients with HER-2-positive metastatic breast cancer were continuously measured with CW-Doppler ultrasound for cardiac output (CO) and systemic vascular resistance (SVR) before, during and after drug infusion in combination with nt-pro-BNP before and 10 min after drug infusion. Depending on the nt-pro-BNP-levels <125 pg/ml (group A, n=34, 51+/-11 years) vs. nt-pro-BNP >125 pg/ml (group B, n=14, 63+/-7 years) two groups have been defined.


RESULTS
Trastuzumab therapy did not change nt-pro-BNP immediately before (44+/-29 pg/ml) vs. after the infusion (45+/-32 pg/ml, n.s.) in the low-level as in the high level nt-pro-BNP group (231+/-356 pg/ml prior and 240+/-377 pg/ml, n.s.). Cardiac output remained stable during trastuzumab infusion, however cardiac output was significantly increased following the end of the infusion stronger in the high-level nt-pro-BNP group. Systemic vascular resistance prior to the trastuzumab infusion was higher in the high-level nt-pro-BNP group with significant decrement during and after the infusion.


CONCLUSIONS
Combining real-time CW-Doppler ultrasound and nt-pro-BNP monitoring is feasible to monitor the immediate hemodynamic changes during and after trastuzumab infusion.
Knobloch
K
K
Tepe
J
J
Lichtinghagen
R
R
Luck
H J
HJ
Vogt
P M
PM
D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized; D000951:Antigens, Neoplasm / Q000097:blood; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D002302:Cardiac Output; D006321:Heart / Q000187:drug effects*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007167:Immunotherapy / Q000009:adverse effects* / Q000379:methods; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000276:immunology*; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D000068878:Trastuzumab; D014655:Vascular Resistance
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000951:Antigens, Neoplasm; D000970:Antineoplastic Agents; D015415:Biomarkers; D020097:Natriuretic Peptide, Brain; D010446:Peptide Fragments; D018719:Erb-b2 Receptor Tyrosine Kinases; D000068878:Trastuzumab; C109794:pro-brain natriuretic peptide (1-76)