Key result
A 9-week duration of trastuzumab significantly reduced the risk of cardiotoxicity compared to a 12-month duration (OR 0.38), whereas cardioprotective drugs failed to prevent cardiotoxic effects.
Why the study?
Trastuzumab is associated with a risk of cardiotoxicity, prompting an evaluation of interventions to prevent trastuzumab-related cardiotoxic effects in breast cancer patients.
Do short-duration trastuzumab or cardioprotective drugs prevent cardiotoxicity in breast cancer patients receiving trastuzumab?
Meta-Analysis (n=12,144)
Do short-duration trastuzumab or cardioprotective drugs prevent cardiotoxicity in breast cancer patients receiving trastuzumab?
A 9-week duration of trastuzumab reduces cardiotoxicity compared to the standard 12-month regimen, whereas prophylactic use of cardioprotective drugs (ACEI, ARB, beta-blockers) fails to prevent trastuzumab-related cardiotoxicity in breast cancer patients.
Background: Trastuzumab is associated with the risk of cardiotoxicity. Here, we aim to explore interventions for preventing trastuzumab-related cardiotoxic effects in breast cancer patients. Methods: A systematic review was performed including trials of breast cancer patients with intervention to prevent cardiotoxicity of trastuzumab. Trials were searched through databases including PubMed, Embase, and Cochrane Library. Results: Eight RCTs were included. Five trials reported the outcomes of short-duration interventions, including 6-month and 9-week durations, and only 9-week treatment has a significant difference from the 12-month group (OR 0.38; 95% CI 0.18–0.83) using cardiotoxicity as the outcome. However, 6-month treatment turned out to yield less occurrence of trastuzumab discontinuation (OR 0.32; 95% CI 0.24–0.42). Three trials reported interventions of cardioprotective drugs, and there is no significant difference shown in any cardioprotective group compared with placebo (cardiotoxicity outcome: angiotensin-converting enzyme inhibitor: OR 0.48; 95% CI 0.057–2.3; angiotensin receptor blocker: OR 1.3; 95% CI 0.12–14; β-blocker: OR 0.48; 95% CI 0.057–2.3; trastuzumab interruption outcome: angiotensin-converting enzyme inhibitor: OR 0.45; 95% CI 0.12–1.3; angiotensin receptor blocker: OR 0.87; 95% CI 0.15–4.8; β-blocker: OR 0.41; 95% CI 0.11–1.2). Conclusion: Only the 9-week group has a significant difference from the 12-month group using cardiotoxicity as the outcome. And 6-month treatment turned out to yield less occurrence of trastuzumab discontinuation. The use of cardioprotective drugs failed to prevent trastuzumab-related cardiotoxic effects in breast cancer patients.
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Li et al. (2021) conducted a meta-analysis in Breast cancer receiving trastuzumab (n=12,144). Short duration of trastuzumab (9 weeks) vs. 12-month trastuzumab was evaluated on Cardiotoxicity (OR 0.38, 95% CI 0.18-0.83, p=0.015). A 9-week duration of trastuzumab significantly reduced the risk of cardiotoxicity compared to a 12-month duration (OR 0.38), whereas cardioprotective drugs failed to prevent cardiotoxic effects.
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