Early Decline in Left Ventricular Ejection Fraction Can Predict Trastuzumab-Related Cardiotoxicity in Patients with Breast Cancer: A Study Using 13 Years of Registry Data

• Published in: Cancer research and treatment 2019, 51(2), , pp.727-736
• Main Authors: Kim, Eun Kyoung, Cho, Jinhyun, Kim, Ji-Yeon, Chang, Sung-A, Park, Sung-Ji, Choi, Jin Oh, Lee, Sang Chol, Ahn, Jin Seok, Park, Seung Woo, Im, Young-Hyuck, Jeon, Eun Seok, Park, Yeon Hee
• Format: Article
• Language: English
• Subjects: Adult; Antineoplastic Agents, Immunological - adverse effects; Antineoplastic Agents, Immunological - therapeutic use; Biomarkers; Breast Neoplasms - complications; Breast Neoplasms - drug therapy; Breast Neoplasms - epidemiology; Breast Neoplasms - mortality; Cardiotoxicity; Comorbidity; Female; Health Care Surveys; Humans; Kaplan-Meier Estimate; Middle Aged; Original; Prognosis; Proportional Hazards Models; Registries; Risk Factors; Stroke Volume; Trastuzumab - adverse effects; Trastuzumab - therapeutic use; Ventricular Dysfunction, Left - diagnosis; Ventricular Dysfunction, Left - epidemiology; Ventricular Dysfunction, Left - etiology; Ventricular Dysfunction, Left - physiopathology; 의약학
• ISSN: 1598-2998; 2005-9256
• DOI: 10.4143/crt.2018.262

While concerns regarding trastuzumab-related cardiac dysfunction (TRCD) in patients with breast cancer are increasing, there is a lack of evidence supporting the current recommendations for TRCD monitoring. We aimed to investigate the clinical predictors of TRCD in the adjuvant setting of human epidermal growth factor receptor 2-positive breast cancer patients. From August 2003 to April 2016, consecutive 998 patients who were treated with adjuvant trastuzumab for breast cancer were retrospectively evaluated. TRCD was defined as a decrease ≥10% in left ventricular ejection fraction (LVEF), with a decline below the normal limit or symptomatic heart failure. Among 787 eligible patients who had complete data sets consisting of both baseline and follow-up assessment of left ventricular systolic function by echocardiography (mean age, 49.9±9.5 years), 58 (7.4%) developed TRCD. TRCD patients had lower baseline LVEF (63% [59-66] vs. 65% [61-68], p=0.016) and more frequently administered Adriamycin (98% vs. 89%, p=0.022) than those without TRCD. On follow-up echocardiography, a drop in LVEF ≥5% within the first 3 months was more frequent in TRCD patients (78.3% vs. 38.4%, p