Cardiac toxicity with trastuzumab: acceptable and reversible?
- PDF / 124,330 Bytes
- 1 Pages / 623.591 x 841.847 pts Page_size
- 18 Downloads / 182 Views
1
Cardiac toxicity with trastuzumab: acceptable and reversible? Trastuzumab use appears to be associated with cardiac toxicity in patients with metastatic breast cancer, but the toxicity appears to be reversible, according to results of a retrospective analysis.1 However, Drs Daniel F Hayes and Michael H Picard say that trastuzumab must continue to be given to those who will benefit from it despite its downside.2 173 patients with metastatic breast cancer treated with trastuzumab (aged 26–79 years) for ≥ 1 year were assessed to determine the cardiac safety of long-term trastuzumab;1 the median cumulative time receiving trastuzumab was 21.3 months, and median follow-up was 33.6 months. A cardiac event* occurred in 28.3% (n = 49) of patients, including asymptomatic decrease in left ventricular ejection fraction (LVEF) of 20 percentage points (1.7% of patients), grade 2 cardiac toxicity (15.6%), grade 3 cardiac toxicity (10.4%) and cardiacrelated death (0.5%);1 trastuzumab was discontinued in 31 of those patients. With or without cardiac therapy or trastuzumab discontinuation, all but three of the 49 patients had cardiac recovery or did not experience any cardiac symptoms. After complete cardiac function recovery, 26 patients were re-treated with trastuzumab; of those, 16 did not have further cardiac toxicity. The hazard of a cardiac event in patients treated with concomitant taxanes was higher early in follow-up and decreased during follow-up, relative to trastuzumab alone; the hazard for trastuzumab alone increased in follow-up. Furthermore, baseline LVEF was significantly associated with a cardiac event. The researchers say that their study suggests that trastuzumab-induced pathological changes are reversible with medical therapy.1 Dr Hayes and Dr Picard from the University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, and the Massachusetts General Hospital and Havard Medical School, Boston, Massachusetts, respectively, in the US say that "we should err on the side of caution" when using trastuzumab in patients with evidence of heart failure, and that it is essential that the "astonishing" beneficial effects of trastuzumab continue to be delivered to those who will benefit, while avoiding major toxicities.2 * decrease in LVEF below the normal level, decrease of 20 percentage points in LVEF versus baseline, or sign or symptoms of congestive heart failure 1. Guarneri V, et al. Long-term cardiac tolerability of trastuzumab in metastatic breast cancer: the M.D. Anderson Cancer Center experience. Journal of Clinical Oncology 24: 4107-4115, No. 25, 1 Sep 2006. 2. Hayes DF. Heart of darkness: the downside of trastuzumab. Journal of Clinical Oncology 24: 4056-4058, No. 25, 1 Sep 2006. 801069184
0114-9954/10/1116-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 26 Aug 2006 No. 1116
Data Loading...
