Key result
Compared to shorter treatment durations, 12 months of adjuvant trastuzumab yielded higher odds for the occurrence of relevant cardiac events and premature discontinuation due to cardiotoxicity.
Why the study?
Trastuzumab-associated cardiotoxicity may be more frequent with 12 months of treatment compared with shorter treatment lengths in early-stage, HER2-positive breast cancer.
Does 12 months of adjuvant trastuzumab increase cardiotoxicity compared to shorter regimens in patients with early-stage HER2-positive breast cancer?
Meta-Analysis
Does 12 months of adjuvant trastuzumab increase cardiotoxicity compared to shorter regimens in patients with early-stage HER2-positive breast cancer?
In patients with early-stage HER2-positive breast cancer, 12 months of adjuvant trastuzumab is associated with a higher risk of cardiotoxicity compared to shorter treatment durations.
May support shorter trastuzumab regimens to reduce cardiotoxicity in HER2+ breast cancer; extends trial data and leaves open optimal personalization via patient-level analyses.
BACKGROUND: Treatment de-escalation in early-stage, human epidermal growth factor receptor 2 (HER2)-positive breast cancer (BC) has been attempted in order to decrease costs and toxicities. One of the strategies pursued is decreasing trastuzumab treatment duration, with mixed results thus far. Trastuzumab-associated cardiotoxicity, however, may be more frequent with 12 months of trastuzumab compared with shorter treatment lengths. Therefore, we have conducted a meta-analysis to address this question. MATERIALS AND METHODS: A meta-analysis of trials testing 12 months of adjuvant trastuzumab versus shorter regimens, reporting cardiac outcomes in patients with HER2-positive BC was performed with the random effects model with inverse variance weighting. RESULTS: =78.8%) for premature trastuzumab discontinuation due to cardiotoxicity for 12 months versus shorter trastuzumab regimens. Funnel plot analyses indicated a low risk of publication bias. CONCLUSIONS: Compared to shorter treatment durations, there is sufficient evidence that 12 months of trastuzumab yields higher odds for the occurrence of relevant cardiac events. An individual patient-level data meta-analysis is needed in order to provide adequate data on risk factors for cardiotoxicity.
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Eiger et al. (2020) conducted a meta-analysis in HER2-positive breast cancer. Trastuzumab vs. Shorter trastuzumab regimens was evaluated on Premature trastuzumab discontinuation due to cardiotoxicity. Compared to shorter treatment durations, 12 months of adjuvant trastuzumab yielded higher odds for the occurrence of relevant cardiac events and premature discontinuation due to cardiotoxicity.
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