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

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 epid...

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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
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creator Kim, Eun Kyoung
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Im, Young-Hyuck
Jeon, Eun Seok
Park, Yeon Hee
description 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
doi_str_mv 10.4143/crt.2018.262
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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&lt;0.001). Regardless of baseline LVEF and Adriamycin treatment, a drop in LVEF ≥5% within the first 3 months of trastuzumab administration was strongly associated with the development of TRCD (adjusted hazard ratio, 45.1[17.0-127.6], p&lt;0.001). The overall incidence of TRCD was 7.4% in Asian breast cancer patients treated with adjuvant trastuzumab. A decline in LVEF ≥5% within the first 3 months of trastuzumab initiation was strongly associated with TRCD development in patients with breast cancer.</description><identifier>ISSN: 1598-2998</identifier><identifier>EISSN: 2005-9256</identifier><identifier>DOI: 10.4143/crt.2018.262</identifier><identifier>PMID: 30177584</identifier><language>eng</language><publisher>Korea (South): Korean Cancer Association</publisher><subject>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</subject><ispartof>Cancer Research and Treatment, 2019, 51(2), , pp.727-736</ispartof><rights>Copyright © 2019 by the Korean Cancer Association 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c418t-722472328e7eaea396e318579da5217b25c84200c1a9c535d5e214dcb53916cd3</citedby><cites>FETCH-LOGICAL-c418t-722472328e7eaea396e318579da5217b25c84200c1a9c535d5e214dcb53916cd3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6473274/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6473274/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30177584$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://www.kci.go.kr/kciportal/ci/sereArticleSearch/ciSereArtiView.kci?sereArticleSearchBean.artiId=ART002456172$$DAccess content in National Research Foundation of Korea (NRF)$$Hfree_for_read</backlink></links><search><creatorcontrib>Kim, Eun Kyoung</creatorcontrib><creatorcontrib>Cho, Jinhyun</creatorcontrib><creatorcontrib>Kim, Ji-Yeon</creatorcontrib><creatorcontrib>Chang, Sung-A</creatorcontrib><creatorcontrib>Park, Sung-Ji</creatorcontrib><creatorcontrib>Choi, Jin Oh</creatorcontrib><creatorcontrib>Lee, Sang Chol</creatorcontrib><creatorcontrib>Ahn, Jin Seok</creatorcontrib><creatorcontrib>Park, Seung Woo</creatorcontrib><creatorcontrib>Im, Young-Hyuck</creatorcontrib><creatorcontrib>Jeon, Eun Seok</creatorcontrib><creatorcontrib>Park, Yeon Hee</creatorcontrib><title>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</title><title>Cancer research and treatment</title><addtitle>Cancer Res Treat</addtitle><description>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. 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Regardless of baseline LVEF and Adriamycin treatment, a drop in LVEF ≥5% within the first 3 months of trastuzumab administration was strongly associated with the development of TRCD (adjusted hazard ratio, 45.1[17.0-127.6], p&lt;0.001). The overall incidence of TRCD was 7.4% in Asian breast cancer patients treated with adjuvant trastuzumab. A decline in LVEF ≥5% within the first 3 months of trastuzumab initiation was strongly associated with TRCD development in patients with breast cancer.</abstract><cop>Korea (South)</cop><pub>Korean Cancer Association</pub><pmid>30177584</pmid><doi>10.4143/crt.2018.262</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record>
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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
title 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
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