Key result
HER2-targeted therapy carries a ~10% cardiotoxicity rate, driven by baseline LVEF under 55% and anthracyclines.
Why the study?
HER2-targeting therapies can cause decreased LVEF and heart failure, necessitating long-term cardiotoxicity management as the breast cancer survivor population expands.
What is the incidence of and risk factors for cardiotoxicity in adult patients with HER2-positive breast cancer receiving HER2-targeted therapies in Saudi Arabia?
Cohort (n=212)
No
What is the incidence of and risk factors for cardiotoxicity in adult patients with HER2-positive breast cancer receiving HER2-targeted therapies in Saudi Arabia?
Answers are grounded in this paper and cite their sources.
This study highlights a 10.37% incidence of HER2-targeted therapy-induced cardiotoxicity in a Saudi Arabian breast cancer cohort—particularly among those with baseline LVEF <55% or prior anthracycline use—underscoring the value of risk-stratified LVEF monitoring and early heart failure therapy to enable continuation of cancer treatment.
Background: HER2-targeting therapies may increase the risk of decreased left ventricular ejection fraction (LVEF), potentially leading to heart failure. The growing number of breast cancer survivors due to HER2-targeted treatments necessitates long-term cardiotoxicity management. Method: This retrospective study included HER2-positive breast cancer patients aged 18 or older who received at least 1 dose of HER2-targeting treatment between 2016 and 2020. The primary endpoint was the incidence of cardiotoxicity, defined as LVEF <50% with a 10% decline, LVEF drop by >15%, or onset of symptomatic heart failure. Secondary endpoints included the proportion of patients with baseline LVEF 50% to 55% developing cardiotoxicity, those discontinuing HER2 therapy due to heart failure, those treated with heart failure medications, and those continuing HER2 therapy while on heart failure medications. Another secondary outcome was the development of a hospital protocol for monitoring cardiotoxicity in these patients. Results: A total of 212 patients were included, with a median age of 56.5 years (interquartile range: 43-58 years). Twenty-two patients (10.37%) experienced cardiotoxicity from HER2-targeted treatment. Thirteen patients (6.13%) had asymptomatic heart failure with LVEF decrease of more than 10% to less than 50%. Five patients (2.35%) with LVEF less than 40% had asymptomatic heart failure, while 4 patients (1.88%) had symptomatic heart failure regardless of LVEF decline. HER2-targeted treatment was temporarily discontinued in 3 (13.63%) patients and permanently in 4 (18.18%) patients due to cardiotoxicity. The remaining 15 patients resumed treatment without interruption. Only 13 out of 22 patients were referred to cardiologists and prescribed heart failure medications. Conclusion: Close monitoring of LVEF in patients receiving HER2-targeting therapy can help health care providers initiate anti-heart failure medications to prevent LVEF deterioration and maintain HER2-targeting therapy.
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Shahbar et al. (2024) conducted a cohort in HER2-positive breast cancer receiving HER2-targeted therapy (n=212). HER2-targeted therapy (e.g., trastuzumab, pertuzumab, lapatinib, ado-trastuzumab emtansine) was evaluated on Incidence of cardiotoxicity (defined as LVEF <50% with a 10% decline, LVEF drop by >15%, or onset of symptomatic heart failure).
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