Trastuzumab treatment without prior anthracycline exposure is associated with a very low incidence of congestive heart failure (0% to 0.5%), suggesting cardiac monitoring could be safely reduced.
Does prior anthracycline exposure determine the risk of trastuzumab-induced cardiotoxicity, and can cardiac surveillance be reduced in low-risk patients?
Trastuzumab-induced heart failure is rare (0-0.5%) in patients without prior anthracycline exposure, suggesting that current cardiac surveillance guidelines may be overly aggressive for this low-risk group.
This review critically analyzes the incidence of trastuzumab-induced left ventricular systolic dysfunction and congestive heart failure (CHF), distinguishing between cases with and without prior anthracycline exposure. It highlights the fact that the elevated risk of trastuzumab-induced cardiotoxicity is closely associated with prior anthracycline exposure. In the absence of prior anthracycline exposure, the incidence rates of trastuzumab-induced cardiotoxicity, particularly CHF (ranging from 0% to 0.5%), are largely comparable with those reported in the general population, especially when reversibility is taken into account. Current cardiac surveillance recommendations during trastuzumab treatment have not yet adapted to the increasing adoption of nonanthracycline treatment strategies and the associated low risk of cardiotoxicity. We propose a refined monitoring protocol to reduce the frequency of cardiac evaluations for low-risk to moderate-risk patients, especially those receiving nonanthracycline treatments. By focusing on patients at high risk or those with prior anthracycline exposure, this strategy seeks to optimize the cost-effectiveness of cardiac care in oncology.
Zheng et al. (Thu,) conducted a review in Trastuzumab-induced cardiotoxicity. Trastuzumab was evaluated on Incidence of left ventricular systolic dysfunction and congestive heart failure. Trastuzumab treatment without prior anthracycline exposure is associated with a very low incidence of congestive heart failure (0% to 0.5%), suggesting cardiac monitoring could be safely reduced.