title: Cardiac safety of (neo)adjuvant trastuzumab in the community setting: a single-center experience.
abstract: BACKGROUND
  Trastuzumab improves the survival of patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer (BC). The incidence and long-term impact of trastuzumab-related cardiotoxicity in the community setting is of great clinical importance.
  
  
  METHODS
  Patients with HER2-positive BC treated with (neo)adjuvant trastuzumab were retrospectively evaluated. Cardiotoxicity was defined as cardiac death or absolute decrease in left ventricular ejection fraction of at least 10% to a value less than 50%, or symptomatic heart failure.
  
  
  RESULTS
  We evaluated 237 patients: median age 53 years (range 27-83 years). 40.5% of these patients had received neoadjuvant and 59.5% adjuvant chemotherapy. The majority (83.9%) were treated with an anthracycline-based regimen. Median exposure to trastuzumab was 8 months (range 2-12 months). Cardiotoxicity was diagnosed in 20.2%, but symptoms only occurred in 3.8%. 41.6% recovered cardiac function. None of the risk factors were associated with cardiotoxicity.
  
  
  CONCLUSIONS
  The incidence of trastuzumab-related cardiotoxicity found in this study was slightly higher than those reported in randomized clinical trials. Nevertheless, most patients were asymptomatic. We describe the cardiac outcomes of a non-selected population, which possibly reflects those found in the 'real world'. The risks versus benefits of trastuzumab use remain in favor of treatment, but cardiotoxicity should be monitored.
authors.affiliation: Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Leonardo Gomes
authors.initials: LG
authors.lastname: da Fonseca
authors.affiliation: Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Debora
authors.initials: D
authors.lastname: de Melo Gagliato
authors.affiliation: Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Tiago K
authors.initials: TK
authors.lastname: Takahashi
authors.affiliation: Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Milena Perez
authors.initials: MP
authors.lastname: Mak
authors.affiliation: Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Romualdo
authors.initials: R
authors.lastname: Barroso-Sousa
authors.affiliation: Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Laura
authors.initials: L
authors.lastname: Testa
authors.affiliation: Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Vanessa Petry
authors.initials: VP
authors.lastname: Helena
authors.affiliation: Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Romulo
authors.initials: R
authors.lastname: de Paula Costa
authors.affiliation: Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Paulo M
authors.initials: PM
authors.lastname: Hoff
authors.affiliation: Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Max S
authors.initials: MS
authors.lastname: Mano
keywords: Adjuvant therapy; Breast cancer; Cardiotoxicity; Trastuzumab