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Trastuzumab related cardiotoxicity in nonmetastatic breast cancer: A real-world scenario

Date

03 May 2019

Session

Poster lunch

Presenters

Sarita Shrivastva

Citation

Annals of Oncology (2019) 30 (suppl_3): iii65-iii71. 10.1093/annonc/mdz101

Authors

S. Shrivastva, S.K. Prasad, R. Chennamaneni, B. Stalin, M.L. Konatam, S. Gundeti

Author affiliations

  • Medical Oncology, Nizam's Institute of Medical Sciences, 500082 - Hyderabad/IN
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Background

Trastuzumab, a humanized monoclonal antibody significantly improves outcomes in Her2 neu positive breast cancer. The incidence of cardiotoxicity with trastuzumab is approximately 8-10%. The present study was designed to analyze the incidence and risk factors associated with trastuzmab related cardiotoxicity.

Methods

The present study was a single institutional retrospective analysis of the incidence of trastuzumab induced cardiotoxicity in nonmetastatic invasive breast cancer from January 2011 to December 2018. Trastuzumab induced cardiotoxicity (TIC) was defined as symptomatic heart failure or asymptomatic decline in left ventricular ejection fraction (LVEF) by > 10% or LVEF < 50%. Risk factors analysed were BMI (≥30 vs < 30), history of diabetes, hypertension, coronary artery disease (CAD) (yes or no), left sided radiotherapy (RT) and prior anthracycline (yes or no).

Results

Data of 246 patients with Her2 neu positive breast cancer was collected. Of these, 117(47.5%) received trastuzumab. The median age at presentation was 51 years (range,28-72). Of 117 patients who received adjuvant trastuzumab TIC was seen in 16(13.6%) patients, asymptomatic LV dysfunction in 9.4% and symptomatic LV dysfunction in 4.2% patients. The median baseline ejection fraction of 65% (range, 56 - 72). The median time to development of TIC was 18.5 (range, 3-52) weeks and median trastuzumab cycle for TIC was 6 (range, 2-16). Presence of ≥ 2 risk factors (20%) had significant impact on incidence of TIC compared to < 2 risk factors (p = 0.04). 10 (62.5%) patients were rechallenged with trastuzumab and 6(37.5%) discontinued trastuzumab. Following rechallenge 1 patient developed asymptomatic decline in EF and 1 developed symptomatic heart failure and were stopped completely. No cardiacrelated mortality was seen.

Table: 214P

Risk factors in relation to TIC

Risk factorTIC PresentTIC absentp Value
BMI ≥ 30 < 302 1414 780.54
History of diabetes Yes No3 1321 800.88
History of hypertension Yes No8 831 700.2
CAD Yes No1 152 990.8
Left side RT Yes No9 723 780.012
Prior anthracycline Yes No13 365 360.29

Conclusions

Approximately 14% developed TIC which was higher in real-world population compared to that seen in clinical trials. Left sided RT to chest and presence of 2 or more risk factors had significant impact on development of TIC. Stringent monitoring of cardiac function to avoid cardiotoxicity and prompt resumption of trastuzumab following recovery may further improve outcomes in nonmetastatic breast cancer.

Editorial acknowledgement

Nil

Clinical trial identification

Nil

Legal entity responsible for the study

Department of Medical Oncology, NIMS, Punjagutta, Hyderabad, India.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.

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