title: Trastuzumab-related cardiotoxicity in the elderly: a role for cardiovascular risk factors.
abstract: BACKGROUND
  Elderly breast cancer patients are usually excluded from clinical trials. Nevertheless, with the increasing use of trastuzumab, there is a need to address trastuzumab-related cardiotoxicity in this population.
  
  
  METHODS
  Records for patients ≥ 70 years treated with trastuzumab since 2005 were reviewed. New York Heart Association classification was used to document symptomatic cardiotoxicity. Asymptomatic cardiotoxicity was defined as an absolute drop ≥ 10% with a final left ventricular ejection fraction < 50% or an absolute drop > 20%.
  
  
  RESULTS
  Forty-five patients, median age 75.9 years (range 70-92), were identified. Three of 24 (12.5%) early breast cancer patients and 5 of 21 (23.8%) with advanced disease experienced asymptomatic cardiotoxicity. Four of 45 patients (8.9%), all with advanced breast cancer, developed symptomatic congestive heart failure. All but one of them recovered in a median time of 5 weeks (range 3-21). Patients with trastuzumab-related cardiotoxicity presented more often with cardiovascular risk factors, such as history of cardiac disease (33% versus 9.1%, P = 0.017) and diabetes (33.3% versus 6.1%, P = 0.010), compared with those without.
  
  
  CONCLUSIONS
  Elderly breast cancer patients with a history of cardiac disease and/or diabetes treated with trastuzumab have an increased incidence of cardiotoxicity. Continuous cardiac monitoring is especially advised in this population.
authors.affiliation: Breast Cancer Center, Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona, Spain. ceserran@vhebron.net
authors.forename: C
authors.initials: C
authors.lastname: Serrano
authors.forename: J
authors.initials: J
authors.lastname: Cortés
authors.forename: L
authors.initials: L
authors.lastname: De Mattos-Arruda
authors.forename: M
authors.initials: M
authors.lastname: Bellet
authors.forename: P
authors.initials: P
authors.lastname: Gómez
authors.forename: C
authors.initials: C
authors.lastname: Saura
authors.forename: J
authors.initials: J
authors.lastname: Pérez
authors.forename: M
authors.initials: M
authors.lastname: Vidal
authors.forename: E
authors.initials: E
authors.lastname: Muñoz-Couselo
authors.forename: M J
authors.initials: MJ
authors.lastname: Carreras
authors.forename: G
authors.initials: G
authors.lastname: Sánchez-Ollé
authors.forename: J
authors.initials: J
authors.lastname: Tabernero
authors.forename: J
authors.initials: J
authors.lastname: Baselga
authors.forename: S
authors.initials: S
authors.lastname: Di Cosimo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000150:complications / Q000188:drug therapy*; D018270:Carcinoma, Ductal, Breast / Q000150:complications / Q000188:drug therapy*; D048909:Diabetes Complications / Q000139:chemically induced; D005260:Female; D006333:Heart Failure / Q000139:chemically induced*; D006801:Humans; D015999:Multivariate Analysis; D012307:Risk Factors; D000068878:Trastuzumab
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000068878:Trastuzumab