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Trastuzumab mediated cardiotoxicity in the setting of adjuvant chemotherapy for breast cancer: a retrospective study

  • Epidemiology
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Abstract

Background The incidence and management of trastuzumab-mediated cardiotoxicity outside of clinical trials has not been well described. Objective and methods The aim of the study was to retrospectively evaluate the incidence of cardiac dysfunction, characterize its natural history, and identify the degree of reversibility using cardiac MRI, in a population of HER-2 positive breast cancer patients receiving trastuzumab in the adjuvant setting. Results Out of 152 patients (mean age 52 ± 10 years), 36 (24%) developed trastuzumab mediated cardiomyopathy, the majority asymptomatic. Factors that predicted the development of trastuzumab mediated cardiac dysfunction were a pre-existing history of hypertension, smoking history, and a family history of coronary artery disease. Within 3 months of treatment with trastuzumab, there was a difference in LVEF between the normal cohort and those patients who developed LV systolic dysfunction (61 ± 5% vs. 51 ± 8%, P < 0.01). During the 6-month-followup, 34/36 patients demonstrated subepicardial linear delayed enhancement of the lateral wall of the left ventricle on cardiac MRI, suggesting trastuzumab induced myocarditis. Conclusion Approximately 1 in 4 women may develop LV systolic dysfunction after treatment with adjuvant trastuzumab, necessitating careful patient selection and close serial monitoring using noninvasive cardiac imaging.

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Acknowledgments

Source of funding: The present study was supported by the Manitoba Medical Services Foundation, St. Boniface General Hospital and Research Foundation, and the Health Sciences Centre Research Foundation. Dr. Davinder S. Jassal is the recipient of the F. W. Du Val clinical research professorship and Heart and Stroke Foundation New Investigator award.

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Authors and Affiliations

  1. Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada

    Deepa Wadhwa

  2. Cardiology Division, Department of Cardiac Sciences, Institute of Cardiovascular Sciences, St. Boniface General Hospital, University of Manitoba, Winnipeg, Manitoba, Canada

    Nazanin Fallah-Rad, Tielan Fang, Roien Ahmadie, Jonathan R. Walker & Davinder S. Jassal

  3. Oncology Division, Department of Internal Medicine, St. Boniface General Hospital, University of Manitoba, Winnipeg, Manitoba, Canada

    Debjani Grenier & Marianne Krahn

  4. Department of Pharmacy, CancerCare Manitoba, Winnipeg, Manitoba, Canada

    Danica Lister

  5. Cardiac Surgery Division, Department of Cardiac Sciences, St. Boniface General Hospital, University of Manitoba, Winnipeg, Manitoba, Canada

    Rakesh C. Arora

  6. Cardiology Division, Department of Cardiac Sciences, St. Boniface General Hospital, University of Manitoba, Rm Y3010, Bergen Cardiac Care Centre, 409 Taché Avenue, Winnipeg, Manitoba, Canada, R2H 2A6

    Ivan Barac, Andrew Morris & Davinder S. Jassal

  7. Department of Radiology, St. Boniface General Hospital, University of Manitoba, Winnipeg, Manitoba, Canada

    Davinder S. Jassal

Authors
  1. Deepa Wadhwa
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  2. Nazanin Fallah-Rad
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  3. Debjani Grenier
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  4. Marianne Krahn
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  5. Tielan Fang
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  6. Roien Ahmadie
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  7. Jonathan R. Walker
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  8. Danica Lister
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  9. Rakesh C. Arora
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  10. Ivan Barac
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  11. Andrew Morris
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  12. Davinder S. Jassal
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Correspondence to Davinder S. Jassal.

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Wadhwa, D., Fallah-Rad, N., Grenier, D. et al. Trastuzumab mediated cardiotoxicity in the setting of adjuvant chemotherapy for breast cancer: a retrospective study. Breast Cancer Res Treat 117, 357–364 (2009). https://doi.org/10.1007/s10549-008-0260-6

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  • DOI: https://doi.org/10.1007/s10549-008-0260-6

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