A Prospective Cohort Study on Cardiotoxicity of Adjuvant Trastuzumab Therapy in Breast Cancer Patients.
BACKGROUND
Cardiotoxicity is an important side effect of trastuzumab therapy and cardiac surveillance is recommended.


OBJECTIVE
The aim of our study was to prospectively assess baseline patients' characteristics, level of N-terminal pro-brain natriuretic peptide (NT-proBNP) and echocardiographic parameters as possible predictors of trastuzumab-related cardiac dysfunction.


METHODS
In a prospective cohort study, clinical, echocardiographic and neurohumoral assessment was performed at baseline, after 4, 8 and 12 months in breast cancer patients undergoing post-anthracycline (3-4 cycles) adjuvant therapy with trastuzumab. Trastuzumab-related cardiac dysfunction was defined as a decline of ≥ 10% in left ventricular ejection fraction (LVEF).


RESULTS
92 patients (mean age, 53.6 ± 9.0 years) were included. Patients who developed trastuzumab-related LVEF decline ≥ 10% (20.6%) during treatment had significantly higher baseline LVEF (70.7 ± 4.4%) than those without (64.8 ± 5.5%) (p = 0.0035). All other measured baseline parameters (age, body mass index, arterial hypertension, level of NT-proBNP and other echocardiographic parameters) were not identified as significant.


CONCLUSIONS
Our findings suggest that baseline patient' characteristics, level of NT-proBNP and echocardiographic parameters, as long as they are within normal range, are not a reliable tool to predict early trastuzumab-related cardiac dysfunction in patients undergoing post-low dose anthracycline adjuvant trastuzumab therapy. A LVEF decline in patients with high-normal baseline level although statistically significant is not clinically relevant.
Division of Medical Oncology, Institute of Oncology Ljubljana, Slovenia.
Erika
E
Matos
Department of Vascular Diseases, University Medical Centre Ljubljana, Slovenia.
Borut
B
Jug
Institute for Biostatistics and Medical Informatics, University of Ljubljana, Slovenia.
Rok
R
Blagus
Division of Medical Oncology, Institute of Oncology Ljubljana, Slovenia.
Branko
B
Zakotnik
D000328:Adult; D000368:Aged; D000818:Animals; D018943:Anthracyclines / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001794:Blood Pressure / Q000187:drug effects; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000188:drug therapy*; D066126:Cardiotoxicity / Q000209:etiology; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000139:chemically induced*; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018719:Erb-b2 Receptor Tyrosine Kinases; D012016:Reference Values; D012307:Risk Factors; D013318:Stroke Volume / Q000187:drug effects; D013997:Time Factors; D000068878:Trastuzumab / Q000009:adverse effects*; D016896:Treatment Outcome
D018943:Anthracyclines; D000970:Antineoplastic Agents; D020097:Natriuretic Peptide, Brain; D010446:Peptide Fragments; D018719:Erb-b2 Receptor Tyrosine Kinases; D000068878:Trastuzumab; C109794:pro-brain natriuretic peptide (1-76); C508053:ERBB2 protein, human