Trastuzumab had higher odds of heart failure reporting relative to other anti-HER2 therapies collectively (ROR 17.37; 99% CI 14.30-21.10).
Observational
Yes
Do different anti-HER2 therapies have varying odds of heart failure reporting in patients with cancer?
Trastuzumab and pertuzumab/T-DM1 are associated with significantly higher odds of heart failure reporting compared to other anti-HER2 therapies, highlighting the need for targeted LVEF monitoring.
Effect estimate: ROR 17.37 (95% CI 14.30-21.10)
Background: Trastuzumab improves outcomes in patients with HER2-overexpressing malignancies but is associated with decreases in left ventricular ejection fraction. Heart failure (HF) risks from other anti-HER2 therapies are less clear. Objectives: Using World Health Organization pharmacovigilance data, the authors compared HF odds across anti-HER2 regimens. Methods: = 5,704; neratinib, n = 1,507; tucatinib, n = 655); additionally, 36,052 patients had ADRs with anti-HER2-based combination regimens. Most patients had breast cancer (monotherapies, n = 17,281; combinations, n = 24,095). Outcomes included comparison of HF odds with each monotherapy relative to trastuzumab, within each therapeutic class, and among combination regimens. Results: Of 16,900 patients with trastuzumab-associated ADRs, 2,034 (12.04%) had HF reports (median time to onset 5.67 months; IQR: 2.85-9.32 months) compared with 1% to 2% with antibody-drug conjugates. Trastuzumab had higher odds of HF reporting relative to other anti-HER2 therapies collectively in the overall cohort (reporting OR ROR: 17.37; 99% CI: 14.30-21.10) and breast cancer subgroup (ROR: 17.10; 99% CI: 13.12-22.27). Pertuzumab/T-DM1 had 3.4 times higher odds of HF reporting than T-DM1 monotherapy; tucatinib/trastuzumab/capecitabine had similar odds as tucatinib. Among metastatic breast cancer regimens, HF odds were highest with trastuzumab/pertuzumab/docetaxel (ROR: 1.42; 99% CI: 1.17-1.72) and lowest with lapatinib/capecitabine (ROR: 0.09; 99% CI: 0.04-0.23). Conclusions: Trastuzumab and pertuzumab/T-DM1 had higher odds of HF reporting than other anti-HER2 therapies. These data provide large-scale, real-world insight into which HER2-targeted regimens would benefit from left ventricular ejection fraction monitoring.
Waliany et al. (Tue,) conducted a observational in HER2-overexpressing malignancies. Trastuzumab vs. Other anti-HER2 therapies was evaluated on Heart failure reporting odds (ROR 17.37, 95% CI 14.30-21.10). Trastuzumab had higher odds of heart failure reporting relative to other anti-HER2 therapies collectively (ROR 17.37; 99% CI 14.30-21.10).