Trastuzumab in female breast cancer patients with reduced left ventricular ejection fraction

Somaira Nowsheen, Khaled Aziz, Jae Yoon Park, Amir Lerman, Hector R Vilarraga, Kathryn J Ruddy, Joerg Herrmann

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background-Trastuzumab is life-extending therapy for breast cancer patients overexpressing the human epidermal growth factor receptor 2 (HER2+), but has known cardiotoxic risk. We sought to determine if trastuzumab can be administered to patients with reduced baseline cardiac function at no higher cardiotoxicity risk than in those with normal cardiac function at baseline. Methods and Results-We performed a retrospective study of women treated with trastuzumab for human epidermal growth factor receptor 2 breast cancer at Mayo Clinic Rochester between January 1, 2000 and August 31, 2015 with pre- and on-therapy echocardiograms available for review. A left ventricular ejection fraction (LVEF) <53% was considered abnormal, and a =10% decline in LVEF as evidence of cardiotoxicity based on the criteria of the American Society of Echocardiography. A total of 428 women were identified; 408 had a normal cardiac function (LVEF 63.4±5%) and 20 had an impaired cardiac function (LVEF 45.4±7%) before trastuzumab. Seven women (35%) with reduced LVEF at baseline had a ≥10% reduction in LVEF, compared with 179 (43.9%) of those with normal LVEF before trastuzumab initiation (P=NS). Symptomatic heart failure developed more often in patients with reduced versus normal baseline LVEF (25% versus 4.2%, P<0.05). After adjusting for patient age and breast cancer disease stage, survival rates over 5 years from time of diagnosis were found to be lower for patients with reduced baseline LVEF compared with patients with normal baseline LVEF (P<0.001); the adjusted proportion of patients surviving at 5 years for those with low LVEF at baseline was 79% and for those with normal LVEF was 93%. Conclusions-Women undergoing trastuzumab therapy for breast cancer with impaired baseline cardiac function experience no higher risk of LVEF decline, but more frequently develop symptomatic heart failure. While trastuzumab could be considered, these patients should be co-managed by a cardiologist.

Original languageEnglish (US)
Article numbere008637
JournalJournal of the American Heart Association
Volume7
Issue number15
DOIs
StatePublished - Aug 1 2018

Fingerprint

Stroke Volume
Breast Neoplasms
Trastuzumab
Heart Failure
Breast Diseases
Therapeutics
Survival Rate
Retrospective Studies

Keywords

  • Breast cancer
  • Cardiomyopathy
  • Cardiotoxicity
  • Chemotherapy
  • Heart failure
  • HER2
  • Left ventricular ejection fraction
  • Trastuzumab
  • Treatment

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Trastuzumab in female breast cancer patients with reduced left ventricular ejection fraction. / Nowsheen, Somaira; Aziz, Khaled; Park, Jae Yoon; Lerman, Amir; Vilarraga, Hector R; Ruddy, Kathryn J; Herrmann, Joerg.

In: Journal of the American Heart Association, Vol. 7, No. 15, e008637, 01.08.2018.

Research output: Contribution to journalArticle

@article{9b50656993f942289561e6aeb33aed09,
title = "Trastuzumab in female breast cancer patients with reduced left ventricular ejection fraction",
abstract = "Background-Trastuzumab is life-extending therapy for breast cancer patients overexpressing the human epidermal growth factor receptor 2 (HER2+), but has known cardiotoxic risk. We sought to determine if trastuzumab can be administered to patients with reduced baseline cardiac function at no higher cardiotoxicity risk than in those with normal cardiac function at baseline. Methods and Results-We performed a retrospective study of women treated with trastuzumab for human epidermal growth factor receptor 2 breast cancer at Mayo Clinic Rochester between January 1, 2000 and August 31, 2015 with pre- and on-therapy echocardiograms available for review. A left ventricular ejection fraction (LVEF) <53{\%} was considered abnormal, and a =10{\%} decline in LVEF as evidence of cardiotoxicity based on the criteria of the American Society of Echocardiography. A total of 428 women were identified; 408 had a normal cardiac function (LVEF 63.4±5{\%}) and 20 had an impaired cardiac function (LVEF 45.4±7{\%}) before trastuzumab. Seven women (35{\%}) with reduced LVEF at baseline had a ≥10{\%} reduction in LVEF, compared with 179 (43.9{\%}) of those with normal LVEF before trastuzumab initiation (P=NS). Symptomatic heart failure developed more often in patients with reduced versus normal baseline LVEF (25{\%} versus 4.2{\%}, P<0.05). After adjusting for patient age and breast cancer disease stage, survival rates over 5 years from time of diagnosis were found to be lower for patients with reduced baseline LVEF compared with patients with normal baseline LVEF (P<0.001); the adjusted proportion of patients surviving at 5 years for those with low LVEF at baseline was 79{\%} and for those with normal LVEF was 93{\%}. Conclusions-Women undergoing trastuzumab therapy for breast cancer with impaired baseline cardiac function experience no higher risk of LVEF decline, but more frequently develop symptomatic heart failure. While trastuzumab could be considered, these patients should be co-managed by a cardiologist.",
keywords = "Breast cancer, Cardiomyopathy, Cardiotoxicity, Chemotherapy, Heart failure, HER2, Left ventricular ejection fraction, Trastuzumab, Treatment",
author = "Somaira Nowsheen and Khaled Aziz and Park, {Jae Yoon} and Amir Lerman and Vilarraga, {Hector R} and Ruddy, {Kathryn J} and Joerg Herrmann",
year = "2018",
month = "8",
day = "1",
doi = "10.1161/JAHA.118.008637",
language = "English (US)",
volume = "7",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "15",

}

TY - JOUR

T1 - Trastuzumab in female breast cancer patients with reduced left ventricular ejection fraction

AU - Nowsheen, Somaira

AU - Aziz, Khaled

AU - Park, Jae Yoon

AU - Lerman, Amir

AU - Vilarraga, Hector R

AU - Ruddy, Kathryn J

AU - Herrmann, Joerg

PY - 2018/8/1

Y1 - 2018/8/1

N2 - Background-Trastuzumab is life-extending therapy for breast cancer patients overexpressing the human epidermal growth factor receptor 2 (HER2+), but has known cardiotoxic risk. We sought to determine if trastuzumab can be administered to patients with reduced baseline cardiac function at no higher cardiotoxicity risk than in those with normal cardiac function at baseline. Methods and Results-We performed a retrospective study of women treated with trastuzumab for human epidermal growth factor receptor 2 breast cancer at Mayo Clinic Rochester between January 1, 2000 and August 31, 2015 with pre- and on-therapy echocardiograms available for review. A left ventricular ejection fraction (LVEF) <53% was considered abnormal, and a =10% decline in LVEF as evidence of cardiotoxicity based on the criteria of the American Society of Echocardiography. A total of 428 women were identified; 408 had a normal cardiac function (LVEF 63.4±5%) and 20 had an impaired cardiac function (LVEF 45.4±7%) before trastuzumab. Seven women (35%) with reduced LVEF at baseline had a ≥10% reduction in LVEF, compared with 179 (43.9%) of those with normal LVEF before trastuzumab initiation (P=NS). Symptomatic heart failure developed more often in patients with reduced versus normal baseline LVEF (25% versus 4.2%, P<0.05). After adjusting for patient age and breast cancer disease stage, survival rates over 5 years from time of diagnosis were found to be lower for patients with reduced baseline LVEF compared with patients with normal baseline LVEF (P<0.001); the adjusted proportion of patients surviving at 5 years for those with low LVEF at baseline was 79% and for those with normal LVEF was 93%. Conclusions-Women undergoing trastuzumab therapy for breast cancer with impaired baseline cardiac function experience no higher risk of LVEF decline, but more frequently develop symptomatic heart failure. While trastuzumab could be considered, these patients should be co-managed by a cardiologist.

AB - Background-Trastuzumab is life-extending therapy for breast cancer patients overexpressing the human epidermal growth factor receptor 2 (HER2+), but has known cardiotoxic risk. We sought to determine if trastuzumab can be administered to patients with reduced baseline cardiac function at no higher cardiotoxicity risk than in those with normal cardiac function at baseline. Methods and Results-We performed a retrospective study of women treated with trastuzumab for human epidermal growth factor receptor 2 breast cancer at Mayo Clinic Rochester between January 1, 2000 and August 31, 2015 with pre- and on-therapy echocardiograms available for review. A left ventricular ejection fraction (LVEF) <53% was considered abnormal, and a =10% decline in LVEF as evidence of cardiotoxicity based on the criteria of the American Society of Echocardiography. A total of 428 women were identified; 408 had a normal cardiac function (LVEF 63.4±5%) and 20 had an impaired cardiac function (LVEF 45.4±7%) before trastuzumab. Seven women (35%) with reduced LVEF at baseline had a ≥10% reduction in LVEF, compared with 179 (43.9%) of those with normal LVEF before trastuzumab initiation (P=NS). Symptomatic heart failure developed more often in patients with reduced versus normal baseline LVEF (25% versus 4.2%, P<0.05). After adjusting for patient age and breast cancer disease stage, survival rates over 5 years from time of diagnosis were found to be lower for patients with reduced baseline LVEF compared with patients with normal baseline LVEF (P<0.001); the adjusted proportion of patients surviving at 5 years for those with low LVEF at baseline was 79% and for those with normal LVEF was 93%. Conclusions-Women undergoing trastuzumab therapy for breast cancer with impaired baseline cardiac function experience no higher risk of LVEF decline, but more frequently develop symptomatic heart failure. While trastuzumab could be considered, these patients should be co-managed by a cardiologist.

KW - Breast cancer

KW - Cardiomyopathy

KW - Cardiotoxicity

KW - Chemotherapy

KW - Heart failure

KW - HER2

KW - Left ventricular ejection fraction

KW - Trastuzumab

KW - Treatment

UR - http://www.scopus.com/inward/record.url?scp=85051434076&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85051434076&partnerID=8YFLogxK

U2 - 10.1161/JAHA.118.008637

DO - 10.1161/JAHA.118.008637

M3 - Article

C2 - 30371238

AN - SCOPUS:85051434076

VL - 7

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 15

M1 - e008637

ER -