11P - Optimal duration of cardiac monitoring in metastatic HER2 positive breast cancer patients receiving trastuzumab

Date 08 May 2014
Event IMPAKT 2014
Session Welcome reception and Poster Walk
Topics Anti-Cancer Agents & Biologic Therapy
Breast Cancer, Metastatic
Presenter Kevin Chiu
Citation Annals of Oncology (2014) 25 (suppl_1): i4-i4. 10.1093/annonc/mdu064
Authors K. Chiu1, S. Dubey2, D. Bull1
  • 1Clinical Oncology, Derriford Hospital, PL6 8DH - Plymouth/UK
  • 2Dept Of Clinical Oncology, Derriford Hospital, PL68DH - Plymouth/UK



Cardiac toxicity is a well-recognised side effect of trastuzumab. NICE UK recommends 3-monthly cardiac function assessments during adjuvant trastuzumab treatment in early breast cancer. However, there is a lack of consensus or established guidance for the duration of cardiac monitoring in advanced breast cancer patients receiving palliative trastuzumab.


The purpose of this retrospective study was to assess the optimal use of cardiac assessments during trastuzumab therapy for patients with metastatic HER2 positive breast cancer.


239 patients received trastuzumab in our centre between Jan 2008 and Dec 2012. 61 of these were metastatic breast cancer patients, who received palliative trastuzumab in combination with chemotherapy or anti-oestrogenic hormonal treatment. These patients' baseline and serial left ventricular ejection fraction readings with transthoracic echocardiograms were noted. Their risk factors for cardiac toxicity, as well as the events leading to cardiac toxicity, were identified from hospital records.


The total number of 3-weekly trastuzumab cycles delivered ranged from 3 to 151. 90% of all patients received regular 3-4-monthly cardiac monitoring with echocardiograms. 11 of the 61 patients (18%) needed interruption of treatment due to cardiac toxicity. The median number of cycles received by patients who had cardiac toxicity was 17, in contrast to 37 cycles in the cohort with no cardiac toxicity (p-value = 0.043). 8 of the 11 patients (72%) developed cardiac toxicity within the first 18 months and 9 (82%) within 24 months of the start of trastuzumab. Of these 11 patients, 8 recovered and were re-challenged with trastuzumab after a median of a 2-month interval. The number of patients with previous ischaemic heart disease (IHD) was significantly higher in the cohort of patients who developed cardiac toxicity. 3 out of 11 (27%) patients in the cohort who developed cardiac toxicity and 2 out of 50 (4%) patients in the non-toxicity cohort had a history of IHD (p-value = 0.037).


Based on our retrospective data, routine cardiac monitoring is recommended for at least 18-24 months.


All authors have declared no conflicts of interest.