Effect at One Year of Adjuvant Trastuzumab for HER2+ Breast Cancer Combined with Radiation or an Anthracycline on Left Ventricular Ejection Fraction

• Published in: The American journal of cardiology 2020-06, Vol.125 (12), p.1906-1912
• Main Authors: Andersen, Mousumi M., Ayala-Peacock, Diandra, Bowers, Jessie, Kooken, Banks W., D'Agostino, Ralph B., Jordan, Jennifer H., Vasu, Sujethra, Thomas, Alexandra, Klepin, Heidi D., Brown, Doris R., Hundley, W. Gregory
• Format: Article
• Language: English
• Subjects: Adjuvants; Anthracycline; Anthracyclines - therapeutic use; Antineoplastic Agents, Immunological - therapeutic use; Breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - radiotherapy; Cancer therapies; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - etiology; Chemotherapy; Chemotherapy, Adjuvant; Coronary vessels; Demographics; Demography; Diabetes; Ejection fraction; ErbB-2 protein; Female; Health risks; Heart; Humans; Hypertension; Immunotherapy; Medical records; Middle Aged; Monoclonal antibodies; Patients; Radiation; Radiation therapy; Receptor, ErbB-2; Risk analysis; Risk Factors; Stroke Volume - drug effects; Stroke Volume - radiation effects; Targeted cancer therapy; Trastuzumab; Trastuzumab - therapeutic use; Ventricle; Womens health
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2020.03.013

To determine the impact of radiation therapy (XRT) in addition to trastuzumab (TZB) adjuvant chemotherapy for HER2+ breast cancer on left ventricular systolic function, we assessed demographics, oncologic treatment history including XRT exposure, and serial measurements of left ventricular ejection fraction (LVEF) in 135 consecutively identified women receiving TZB for treatment of adjuvant breast cancer. Longitudinal mixed effects models were fit to identify baseline to treatment changes in LVEF among those receiving TZB with or without concomitant anthracycline or XRT. Women averaged 53 ± 3 years in age, 77% were white, 62% patients had 1 or more cardiovascular risk factors at baseline, and mean duration of TZB was 11 ± 5 months. Seventy-seven women were treated with XRT and received between 4000 and 5500 cGy of radiation. The LVEF declined by an average of 3.4% after 1 year for those in the study. Relative to baseline upon completion of adjuvant TZB, LVEF remained reduced for those receiving anthracycline with or without XRT (p=0.002 for both), or XRT alone (p=0.002), but not in those without these therapies. Amongst patients treated only with XRT and TZB, LVEF declined 3.1% on average in those with left-sided disease and 6.9% on average in those with right-sided disease (p= 0.06, p= 0.008 respectively). Among women receiving TZB for adjuvant treatment of HER-2 positive breast cancer, the administration of XRT, anthracycline, or the combination of the 2 is associated with a persistent post-treatment as opposed to a temporary treatment related decline in LVEF.