Trastuzumab-related cardiotoxicity reduces left ventricular ejection fraction in elderly women with diabetes or heart disease.

Trastuzumab is a monoclonal antibody that affects the human epidermal growth factor receptor-2 (HER2).  Trastuzumab is frequently used in young women diagnosed with HER2 breast cancer. A new study by Dr César Serrano et al published in Annals of Oncology found that trastuzumab increases the risk of heart problems, particularly in elderly women with a history of heart disease, diabetes, or both.

In the study, 45 women aged >70 years (range, 70-92 years) developed heart disease while on trastuzumab treatment for breast cancer. The study measured whether patients developed asymptomatic cardiotoxicity during which their left ventricular ejection fraction (LVEF) had a drop of 10% or more or if women with advanced breast cancer developed symptomatic cardiotoxicity, ie, some degree of congestive heart failure. Four of 45 patients (8.9%), all with advanced breast cancer, developed symptomatic congestive heart failure. Three of 24 (12.5%) early breast cancer patients and 5 of 21 (23.8%) with advanced disease experienced asymptomatic cardiotoxicity.

However, unlike that of anthracyclines, trastuzumab’s cardiotoxicity is reversible. A decrease in LVEF could be associated with a loss of contractility but does not result in myocyte destruction. According to this study, continuous cardiac monitoring is recommended for elderly women with increased heart problems while taking trastuzumab because of potential trastuzumab-related cardiotoxicity.

For more information: Trastuzumab-related cardiotoxicity in the elderly: a role for cardiovascular risk factors

References

Procter M, Suter TM, de Azambuja E, et al. Longer-term assessment of trastuzumab-related cardiac adverse events in the Herceptin Adjuvant (HERA) trial. J Clin Oncol. 2010;28:3422-3428.

Piccart-Gebhart MJ, Procter M, Leyland-Jones B, et al. Trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer. N Engl J Med. 2005;353:1659-1672.

Suter TM, Procter M, van Veldhuisen DJ, et al. Trastuzumab-associated cardiac adverse effects in the herceptin adjuvant trial. J Clin Oncol. 2007;25:3859-3865.