Key result
Adjuvant trastuzumab was associated with a 39.5% incidence of cardiotoxicity among Asian breast cancer patients, which is higher than previously reported rates in Caucasians.
Why the study?
What is the incidence and what are the risk factors for cardiotoxicity in Asian breast cancer patients receiving adjuvant trastuzumab?
Cohort (n=314)
No
What is the incidence and what are the risk factors for cardiotoxicity in Asian breast cancer patients receiving adjuvant trastuzumab?
Adjuvant trastuzumab is associated with a high rate of cardiotoxicity (39.5%) in Asian breast cancer patients, highlighting the need for careful LVEF monitoring, especially in those with prior anthracycline use or lower baseline LVEF.
Cardiotoxicity monitoring in Asian patients on trastuzumab warrants caution; retrospective data leave open questions on ethnic risks and optimal surveillance.
Background: Adjuvant trastuzumab (T)-based chemotherapy reduces relapse and improves overall survival in early breast cancer. However, T-associated cardiotoxicity potentially limits its use. Our study aims to report the incidence, severity and reversibility of cardiotoxicity amongst Asian breast cancer patients. Methods: This is a retrospective review of patients who have received adjuvant T from June 2005 to March 2011 at our centre. CT was defined as a drop in left ventricular ejection fraction (LVEF) to less than 50% and / or reduction of ≥ 10% of baseline. Cardiovascular (CVS) risk factors were defined as having at least one of the following factors: family or previous history of CAD, hypertension, diabetes mellitus, hyperlipidemia and smoking. One-way repeated measures ANOVA was used to evaluate the mean LVEF change and Chi-square test to evaluate the association of demographics and CT. Results: A total of 314 female patients were reviewed. CT was reported in 124 (39.5%), of whom 96 had asymptomatic decline in LVEF and 28 were symptomatic. T was withheld (n=53) due to asymptomatic decline in LVEF (n=40), symptomatic heart failure (n=3) and both (n=10). Forty-three patients with resolution of CHF (n=11) or LVEF recovery (n=32) were rechallenged. Cardiotoxicity recurred in 14 - asymptomatic decline in LVEF (n=10), recurrent CHF (n=1) and both (n=3). Overall, there were no cardiac-related deaths. Factors that predicted for CT included low normal pre-trastuzumab LVEF (<60%) (p=0.01), prior anthracyclines (p=0.011), decline in LVEF pre-anthracycline and before T (p=0.022) and BMI ≥ 23kg/m2 (p=0.018). Three-monthly LVEF showed statistically significant decline against baseline over the time points (p=0.005). As expected, the decline in LVEF demonstrated significant interaction with CT groups and non CT group (p<0.001). Conclusions: A higher incidence of CT (39.5%) was observed among Asian breast cancer patients compared to previously reported in Caucasians (24%). Although 77.4% of patients presented with asymptomatic decline in LVEF, approximately one-third of patients experienced recurrent CT upon rechallenge. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-18-05.
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Shih et al. (2011) conducted a cohort in Early breast cancer (n=314). Adjuvant trastuzumab was evaluated on Incidence of cardiotoxicity (drop in LVEF to <50% and/or reduction of ≥ 10% of baseline). Adjuvant trastuzumab was associated with a 39.5% incidence of cardiotoxicity among Asian breast cancer patients, which is higher than previously reported rates in Caucasians.
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