P-086 - Trastuzumab induced cardiotoxicity in Her2 positive metastatic oeso-gastric cancers

Date 04 July 2015
Event WorldGI 2015
Session Posters
Topics Anti-Cancer Agents & Biologic Therapy
Oesophageal Cancer
Complications of Treatment
Gastric Cancer
Presenter J. Martin-Babau
Citation Annals of Oncology (2015) 26 (suppl_4): 1-100. 10.1093/annonc/mdv233
Authors J. Martin-Babau1, Y. Eusen1, C. Verveur2, F. Trouboul3, C. Cheneau4, V. Jestin-Le Tallec4, H. Simon4, J.-. Metges5
  • 1Medical Oncology Brest University Hospital, Brest/FR
  • 2CHU Augustin Morvan, Brest/FR
  • 3CHU Morvan Brest, Brest/FR
  • 4Institut de Cancérologie et d'Hématologie, Brest/FR
  • 5C.H.U. Hopital Morvan, Brest/FR

Abstract

Introduction

Trastuzumab is widely used in Her2 positive metastatic oesophageal and gastric cancers along with chemotherapy. Cardiotoxicity of trastuzumab has been described precisely in Her2 positive breast cancers and occurs with asymptomatic lowering of LVEF (Left Ventricular Ejection Fraction) in up to 10-15% of cases depending on the study. Oeso-gastric cancer patients are usually older and have more comorbidities than patients followed for breast cancer.

Methods

This monocentric retrospective study measured the incidence of symptomatic and asymptomatic cardiotoxicity in patients followed for metastatic oeso-gastric cancers from October 2009 to September 2014. Patients should receive trastuzumab along with concomitant chemotherapy during the period of study for treatment of Her2 positive metastatic oeso-gastric cancer as a first line chemotherapy.

The primary endpoint was to assess the incidence of cardiotoxicity in oeso-gastric Her2 metastatic cancer treated with trastuzumab and its potential impact regarding overall survival, progression-free survival, response rate and side effects.

Results

23 patients received trastuzumab along with chemotherapy during the period of study for treatment of Her2 positive metastatic oeso-gastric cancer as a first line chemotherapy. All patients received trastuzumab concomitantly with 5FU (or capecitabine) initially followed by trastuzumab alone in maintenance monotherapy. 21 patients received 5FU and cisplatinum based chemotherapy. Median age was 62.3 years; sex ratio 18 M/5 W. 8 patients (43%) had received previous chemotherapy in the adjuvant settings. The median number of cycles of trastuzumab was 5 cycles. The asymptomatic cardiotoxicity rate, defined by a drop of more than 10% of LVEF between the enrollment echocardiogram and the third month treatment echocardiogram, was of 26%. Symptomatic cardiotoxicity was observed in two patients (8,6%), with one cardiac failure and one myocardial infarction, with no associated death. Cardiovascular comorbidities and cardiac irradiation, which is recurrent in this indication, did not appear as a predictive factor of cardiotoxicity (p = 1). The cardiologic follow-up of these patients was regular, in comparison to the guidelines for the management of trastuzumab in breast cancer patients, in 43% of patients (n = 10) with an evaluation of LVEF every three months. Overall survival of patients was not statistically modified by the occurring of cardiotoxicity even if we noted a trend to better outcome of the patients presenting an asymptomatic LVEF lowering.

Conclusion

This study is to our knowledge the first to focus specifically on the cardiotoxicity of trastuzumab in oeso-gastric metastatic Her2 positive cancer in the real world.

These patients seem to be at a higher asymptomatic cardiac risk than breast cancer patients.

As in breast cancer with observed asymptomatic LVEF mostly in the three first months of treatment.

However cardiovascular comorbidities didn't appear as predictive factors of trastuzumab induced cardiotoxicity and should not prevent patient from benefiting of this treatment.

Figure: P-086. Overall survival of patients depending on the presence of cardiotoxicity or not.