Key result
Adjuvant trastuzumab with cardiac monitoring achieves ~78% on-schedule completion, while new guidelines increase cardiology interventions.
Why the study?
The impact of new, less stringent UK cardiac monitoring guidelines on trastuzumab treatment delivery and cardiac outcomes in routine clinical practice was unclear.
What is the impact of new UK cardiac monitoring guidelines on treatment delivery and cardiological intervention in patients receiving adjuvant trastuzumab?
Observational (n=110)
What is the impact of new UK cardiac monitoring guidelines on treatment delivery and cardiological intervention in patients receiving adjuvant trastuzumab?
New UK cardiac monitoring guidelines for trastuzumab may allow more patients to complete therapy on schedule but will likely increase the need for ACE inhibitors and cardiology referrals.
May enable near-complete trastuzumab delivery in practice; leaves open whether added cardiological interventions justify the approach without prospective data.
Trastuzumab delivery and changes in left ventricular ejection fraction (LVEF) in 110 patients receiving adjuvant trastuzumab in routine practice are investigated. The potential impact of new, less stringent UK cardiac monitoring guidelines is examined. 86 patients (78%) completed trastuzumab on schedule. 11 (10%) completed treatment despite delay(s) to allow LVEF recovery, 7 (6%) discontinued trastuzumab because of insufficient LVEF recovery, 2 (2%) of whom developed symptomatic cardiotoxicity. 6 (5%) discontinued trastuzumab for non-cardiac reasons. With the newer guidelines, the value of LVEF lower limit of normal is important in determining the proportion of patients who require angiotensin-converting enzyme inhibitors (ACEIs) and cardiology referral: up to 100% could potentially complete trastuzumab on schedule with up to 60% receiving ACEIs and 25% requiring cardiology referral. Adjuvant trastuzumab was well tolerated overall. The new guidelines potentially allow more patients to complete trastuzumab on schedule but require higher levels of cardiological intervention.
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Murray et al. (2010) conducted an observational in Patients receiving adjuvant trastuzumab (n=110). Adjuvant trastuzumab was evaluated on Completion of trastuzumab on schedule. In routine practice, 78% of patients completed adjuvant trastuzumab on schedule, with new UK guidelines potentially allowing up to 100% completion at the cost of higher cardiological intervention.
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