Why the study?
Data were limited on the safety and cardiotoxicity of lapatinib in patients with prior cardiac disorders induced by trastuzumab.
Does lapatinib cause further deterioration of cardiac function in HER2-positive breast cancer patients with previous trastuzumab-induced cardiotoxicity?
Observational (n=10)
No
Does lapatinib cause further deterioration of cardiac function in HER2-positive breast cancer patients with previous trastuzumab-induced cardiotoxicity?
Lapatinib may be safely administered without causing further deterioration of cardiac function in patients with HER2-positive breast cancer who have previously experienced trastuzumab-induced cardiotoxicity.
Lapatinib may be feasible after trastuzumab cardiotoxicity; leaves open long-term safety and efficacy questions pending prospective data.
Background: Cardiotoxicity is a significant adverse event of trastuzumab, which is used in human epidermal growth factor receptor 2 (HER2)-positive breast cancer patients. Lapatinib (Lap) is a small molecule tyrosine kinase inhibitor of HER1 and HER2, serving as an anti-HER2 treatment. Lap reportedly causes lesser cardiotoxicity than does trastuzumab. In clinical practice, Lap is often administered to patients with cardiac disorder (CD) induced by trastuzumab. However, there are only a few reports on the safety of Lap administration and subsequent evaluation of CDs in such patients. We evaluated whether there was a difference in cardiac toxicity due to Lap administration based on the presence or absence of previous cardiotoxicity induced by trastuzumab.Methods: Ten patients who received Lap for the treatment of metastatic or recurrent and HER2-positive breast cancer at the National Center for Global Health and Medicine, Tokyo, Japan, between April 1, 2016 and August 31, 2020, were included in this study. All patients had a history of trastuzumab administration, and two had developed CD after trastuzumab administration. Lap was carefully administered to these two patients after consultation with a cardiologist. Left ventricular ejection fraction (LVEF) and other clinical information before and after Lap treatment were retrieved from electronic medical records. Results: All patients other than the two with CD after trastuzumab treatment had a baseline LVEF of >55%, and there was no clinically relevant decrease in LVEF after the initiation of Lap. The two patients with CD after trastuzumab treatment exhibited LVEF of 38% and 51% after Lap treatment, respectively.Conclusion: Our data indicate that Lap can be administered without causing further deterioration of cardiac function in patients with CD induced by anti-HER2 monoclonal antibodies. The number of cases must be expanded for further investigation.
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Shimanuki et al. (2022) conducted an observational in Metastatic or recurrent HER2-positive breast cancer (n=10). Lapatinib vs. Patients without previous cardiotoxicity was evaluated on Change in left ventricular ejection fraction (LVEF) before and after lapatinib treatment.
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