The HFA/ICOS risk assessment tool had a 96.4% negative predictive value (95% CI 93.5-98.3) for cancer therapy-related cardiac dysfunction in low-risk patients receiving trastuzumab.
Cohort (n=496)
No
Does the HFA/ICOS risk assessment tool accurately identify patients at low risk for trastuzumab-induced cancer therapy-related cardiac dysfunction among patients with HER2-positive breast cancer?
The HFA/ICOS risk assessment tool effectively identifies patients at low risk for trastuzumab-induced cardiac dysfunction, suggesting that less frequent LVEF surveillance may be safe for this group.
Effect estimate: NPV 96.4% (95% CI 93.5-98.3)
BACKGROUND: Although patient factors and sequential anthracycline use contribute to risk for cancer therapy-related cardiac dysfunction (CTRCD) with HER2-directed cancer therapy, frequent (every 3 months) left ventricular ejection fraction (LVEF) surveillance is recommended irrespective of baseline risk. OBJECTIVES: The aim of this study was to examine the incidence of trastuzumab-associated CTRCD in a contemporary cohort with HER2-positive breast cancer and assess the performance of a risk assessment tool to identify patients at low risk for CTRCD to guide risk-based surveillance strategies. METHODS: A retrospective cohort of patients with HER2-positive breast cancer treated with trastuzumab at a tertiary cancer center was examined. Patients were categorized as low, medium, and high or very high risk for CTRCD by Heart Failure Association/International Cardio-Oncology Society risk assessment. RESULTS: Of 496 patients treated with trastuzumab, 29.8% also received anthracyclines. Over a median follow-up period of 51 months, 8.7% developed CTRCD, but only 1.6% had associated heart failure (HF). CTRCD rates were 3.6%, 12.8%, and 32.1% in low-risk, medium-risk, and high or very high risk groups, respectively. HF incidence was 0.4% in the low-risk group and 2.1% in the medium-risk group, with no HF in patients at low- or medium-risk who received trastuzumab without anthracyclines. HF was observed in 11% of high-risk patients. The risk assessment had a negative predictive value for CTRCD in low vs moderate- or high-risk patients of 96.4% (95% CI: 93.5%-98.3%). CONCLUSIONS: The findings support the exploration of a prospective personalized risk-based approach to cardiac LVEF surveillance during trastuzumab therapy. Less frequent LVEF monitoring in low-risk patients may optimize resource use and reduce patient burden without compromising safety.
Ali et al. (Tue,) conducted a cohort in HER2-positive breast cancer (n=496). HFA/ICOS risk assessment (low risk category) vs. Moderate- or high-risk category was evaluated on Cancer therapy-related cardiac dysfunction (CTRCD) (NPV 96.4%, 95% CI 93.5-98.3). The HFA/ICOS risk assessment tool had a 96.4% negative predictive value (95% CI 93.5-98.3) for cancer therapy-related cardiac dysfunction in low-risk patients receiving trastuzumab.