SAFE-HEaRt: Rationale and Design of a Pilot Study Investigating Cardiac Safety of HER2 Targeted Therapy in Patients with HER2-Positive Breast Cancer and Reduced Left Ventricular Function.
Human epidermal growth receptor 2 (HER2) targeted therapies have survival benefit in adjuvant and metastatic HER2 positive breast cancer but are associated with cardiac dysfunction. Current U.S. Food and Drug Administration recommendations limit the use of HER2 targeted agents to patients with normal left ventricular (LV) systolic function.



The objective of the SAFE-HEaRt study is to evaluate the cardiac safety of HER2 targeted therapy in patients with HER2 positive breast cancer and mildly reduced left ventricular ejection fraction (LVEF) with optimized cardiac therapy. Thirty patients with histologically confirmed HER2 positive breast cancer (stage I-IV) and reduced LVEF (40% to 49%) who plan to receive HER2 targeted therapy for ≥3 months will be enrolled. Prior to initiation on study, optimization of heart function with beta-blockers and angiotensin converting enzyme inhibitors will be initiated. Patients will be followed by serial echocardiograms and cardiac visits during and 6 months after completion of HER2 targeted therapy. Myocardial strain and blood biomarkers, including cardiac troponin I and high-sensitivity cardiac troponin T, will be examined at baseline and during the study.



LV dysfunction in patients with breast cancer poses cardiac and oncological challenges and limits the use of HER2 targeted therapies and its oncological benefits. Strategies to prevent cardiac dysfunction associated with HER2 targeted therapy have been limited to patients with normal LVEF, thus excluding patients who may receive the highest benefit from those strategies. SAFE-HEaRt is the first prospective pilot study of HER2 targeted therapies in patients with reduced LV function while on optimized cardiac treatment that can provide the basis for clinical practice changes.The Oncologist2017;22:518-525 IMPLICATIONS FOR PRACTICE: Human epidermal growth receptor 2 (HER2) targeted therapies have survival benefit in adjuvant and metastatic HER2 positive breast cancer but are associated with cardiac dysfunction. To our knowledge, SAFE-HEaRt is the first clinical trial that prospectively tests the hypothesis that HER2 targeted therapies may be safely administered in patients with mildly reduced cardiac function in the setting of ongoing cardiac treatment and monitoring. The results of this study will provide cardiac safety data and inform consideration of clinical practice changes in patients with HER2 positive breast cancer and reduced cardiac function, as well as provide information regarding cardiovascular monitoring and treatment in this population.
Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington, D.C., USA.
Filipa
F
Lynce
Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington, D.C., USA.|MedStar Washington Hospital Center, Washington, D.C., USA.|MedStar Heart and Vascular Institute, Washington, D.C., USA.
Ana
A
Barac
Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington, D.C., USA.
Ming T
MT
Tan
MedStar Washington Hospital Center, Washington, D.C., USA.|MedStar Heart and Vascular Institute, Washington, D.C., USA.
Federico M
FM
Asch
Johns Hopkins Kimmel Cancer Center, Sibley Memorial Hospital, Washington, D.C., USA.
Karen L
KL
Smith
Memorial Sloan Kettering Cancer Center, New, York New York, USA.
Chau
C
Dang
Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington, D.C., USA.
Claudine
C
Isaacs
Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington, D.C., USA Sandra.swain@georgetown.edu.
Sandra M
SM
Swain
D000080044:Ado-Trastuzumab Emtansine; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000009:adverse effects; D001943:Breast Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology; D066126:Cardiotoxicity / Q000150:complications / Q000503:physiopathology*; D004452:Echocardiography; D005260:Female; D006321:Heart / Q000187:drug effects / Q000503:physiopathology; D006801:Humans; D008453:Maytansine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D008875:Middle Aged; D058990:Molecular Targeted Therapy; D009367:Neoplasm Staging; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000235:genetics*; D000068878:Trastuzumab / Q000008:administration & dosage / Q000009:adverse effects*; D019210:Troponin I / Q000097:blood; D020107:Troponin T / Q000097:blood; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000139:chemically induced / Q000503:physiopathology*
D000080044:Ado-Trastuzumab Emtansine; D000806:Angiotensin-Converting Enzyme Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D008453:Maytansine; D018719:Erb-b2 Receptor Tyrosine Kinases; D000068878:Trastuzumab; D019210:Troponin I; D020107:Troponin T; C508053:ERBB2 protein, human; C485206:pertuzumab
Breast cancer; Cardiotoxicity; Clinical trial; Molecular targeted therapy