Key result
Very high HFA-ICOS risk is linked to ~25.7-fold higher odds of trastuzumab-related cardiac dysfunction.
Why the study?
The HFA-ICOS risk stratification tool was developed to predict cancer therapy-related cardiac dysfunction (CTRCD), prompting evaluation of its correlation with CTRCD incidence among trastuzumab-treated patients in Saudi Arabia.
Does baseline HFA-ICOS risk stratification predict the incidence of cancer therapy-related cardiac dysfunction (CTRCD) in adult patients with HER2-positive breast cancer receiving trastuzumab therapy?
Cohort (n=369)
No
Does baseline HFA-ICOS risk stratification predict the incidence of cancer therapy-related cardiac dysfunction (CTRCD) in adult patients with HER2-positive breast cancer receiving trastuzumab therapy?
The HFA-ICOS risk stratification tool effectively identifies trastuzumab-treated breast cancer patients at high and very high risk for cardiotoxicity in a Saudi Arabian cohort, supporting risk-adapted cardiac surveillance.
Supports HFA-ICOS stratification for trastuzumab cardiotoxicity risk; hypothesis-generating and requires prospective validation before practice change.
Background Cancer survival rates have improved substantially with advances in cancer therapy; however, treatment-related cardiotoxicity has become a growing concern. Cancer therapy-related cardiac dysfunction (CTRCD) is a recognized adverse effect of anti-HER2 therapies, including trastuzumab. The Heart Failure Association-International Cardio-Oncology Society (HFA-ICOS) risk stratification tool was developed to predict CTRCD risk and guide clinical management. This study assessed the correlation between HFA-ICOS risk stratification and CTRCD incidence in patients receiving trastuzumab therapy at a tertiary care hospital in Saudi Arabia, and the overall incidence of CTRCD in this population. Methods This retrospective cohort study included 369 adult patients who received trastuzumab therapy at King Fahad Specialist Hospital, Dammam, from January to December 2023. HFA-ICOS risk scores were calculated at baseline, and CTRCD was assessed via serial echocardiography over 3–12 months. Associations between risk category and CTRCD were analyzed using Chi-square and Fisher’s exact tests. Results Among 369 patients (mean age 53 ± 11 years; 96.7% female), baseline HFA-ICOS risk stratification classified 57.7% as low risk, 21.1% as medium, 14.6% as high, and 6.5% as very high risk. Overall CTRCD incidence was 10.6% (39/369). CTRCD prevalence increased sharply with risk category: 5.2% in low-risk, 5.1% in medium-risk, 18.5% in high-risk, and 58.3% in very high-risk patients (OR 25.71, 95% CI 9.33–70.82 for very high vs. low risk; p < 0.001). Diabetes mellitus (35.9% vs. 18.2%, p = 0.04) and hypertension (43.6% vs. 24.8%, p = 0.018) were significantly more common among patients who developed CTRCD. Seven patients (1.9%) developed clinically overt heart failure, of whom only one also met CTRCD criteria. Conclusion The HFA-ICOS risk stratification tool effectively predicts CTRCD risk in patients receiving trastuzumab therapy, with incidence rising sharply from low to very high-risk categories. These findings support risk-based cardiac surveillance strategies and highlight diabetes and hypertension as modifiable comorbidities warranting closer monitoring in high-risk patients.
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Alqaseer et al. (2026) conducted a cohort in HER2-positive breast cancer treated with trastuzumab (n=369). Very high baseline HFA-ICOS risk score vs. Low baseline HFA-ICOS risk score was evaluated on Incidence of cancer therapy-related cardiac dysfunction (CTRCD) (OR 25.71, 95% CI 9.33-70.82, p=<0.001). Very high baseline HFA-ICOS risk stratification strongly predicted trastuzumab-related cardiac dysfunction compared to low risk (58.3% vs 5.2%; OR 25.71, 95% CI 9.33-70.82; p<0.001).
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