Asymptomatic changes in cardiac function can occur in ductal carcinoma-in-situ patients following treatment with HER-2/neu–pulsed dendritic cell vaccines

Abstract Background Targeting HER-2/neu with Trastuzumab has been associated with development of cardiac toxicity. Methods Twenty-seven patients with ductal carcinoma in situ (DCIS) of the breast completed an IRB approved clinical trial of a HER-2/neu targeted dendritic cell based vaccine. Four week...

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Bibliographic Details
Published in:The American journal of surgery 2009-10, Vol.198 (4), p.488-494
Main Authors: Bahl, Susan, M.D, Roses, Robert E., M.D, Sharma, Anupama, M.D, Koldovsky, Ursula, Ph.D, Xu, Shuwen, M.D, Weinstein, Susan, M.D, Nisenbaum, Harvey, M.D, Fox, Kevin, M.D, Pasha, Theresa, Zhang, Paul, M.D., Ph.D, Araujo, Louis, M.D, Carver, Joseph, M.D, Czerniecki, Brian J., M.D., Ph.D
Format: Article
Language:English
Subjects:
Adult
Aged
Biological and medical sciences
Breast cancer
Breast Neoplasms - therapy
Cancer Vaccines - adverse effects
Carcinoma, Intraductal, Noninfiltrating - therapy
Cardiac toxicity
DCIS
Dendritic Cells
ErbB-2 protein
Female
General aspects
Genes, erbB-2
Heart
Heart diseases
HER-2
Humans
Immune response
Immune response (cell-mediated)
Immunization
Immunotherapy
Incidence
Kinases
Mammography
Mastectomy
Medical sciences
Middle Aged
Monoclonal antibodies
Patients
Prevention and actions
Public health. Hygiene
Public health. Hygiene-occupational medicine
Scanning
Stroke Volume
Surgery
Targeted cancer therapy
Toxicity
Trastuzumab
Vaccinations
Vaccines
Ventricular Dysfunction - etiology
Ventricular Dysfunction - physiopathology
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Summary:Abstract Background Targeting HER-2/neu with Trastuzumab has been associated with development of cardiac toxicity. Methods Twenty-seven patients with ductal carcinoma in situ (DCIS) of the breast completed an IRB approved clinical trial of a HER-2/neu targeted dendritic cell based vaccine. Four weekly vaccinations were administered prior to surgical resection. All subjects underwent pre- and post-vaccine cardiac monitoring by MUGA/ECHO scanning allowing for a comparison of cardiac function. Results In 3 of 27 vaccinated patients (11%) transient asymptomatic decrements in ejection fraction of greater than 15% were noted after vaccination. Notably, evidence of circulating anti-HER-2/neu antibody was found prior to vaccination in all three patients, but cardiac toxicity was not noted until induction of cellular mediated immune responses. Conclusions This is the first description of HER-2/neu targeted vaccination associated with an incidence of cardiac changes, and the induction of cellular immune responses combined with antibody may contribute to changes in cardiac function.
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2009.06.014