Breast Cancer

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Robust predictive markers are needed for early detection of trastuzumab-related cardiac dysfunction in breast cancer

Letter to the Editor

To the Editor,

I want to congratulate Honda and colleagues for their article in which they evaluated left ventricular diastolic function during trastuzumab treatment in patients with HER2-positive breast cancer. The ratio of mitral peak velocity of early filling (E) to early diastolic mitral annular velocity (e′, E/e′ ratio) as estimated by tissue Doppler imaging is a noninvasive surrogate for the left ventricular diastolic function. They reported that the degree of E/e′ elevation could have a role as a surrogate marker for predicting the left ventricular ejection fraction decline characteristic of trastuzumab-induced cardiotoxicity [1]. It is worth mentioning other specific predictive markers for trastuzumab-related cardiac dysfunction (TRCD). Zardavas et al. [2] explored the prognostic value of cardiac markers [troponins I and T, N-terminal prohormone of brain natriuretic peptide (NT-proBNP)] to identify patients at increased risk for TRCD in patients with early-stage HER2–positive breast cancer receiving trastuzumab (HERA substudy). The authors reported that elevated troponin I or T before trastuzumab is associated with increased risk for TRCD. Furthermore, recent study by Beer et al. [3] investigated new biomarkers associated with doxorubicin- and trastuzumab-induced cancer therapeutics-related cardiac dysfunction (CTRCD) using high-throughput proteomic profiling and they found that high baseline immunoglobulin (Ig) E levels are associated with a lower risk of CTRCD, pointing out the immune system as a potential mediator of CTRCD. As a conclusion, evaluation of baseline Ig E level in addition to aforementioned cardiac markers may robustly identify patients at increased risk for TRCD.


Compliance with ethical standards

Conflict of interest

I have no conflict of interest to declare.


  1. 1.
    Honda K, Takeshita K, Murotani K, Mitsuma A, Hayashi H, Tsunoda N, et al. Assessment of left ventricular diastolic function during trastuzumab treatment in patients with HER2-positive breast cancer. Breast Cancer. 2017;24:312–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Zardavas D, Suter TM, Van Veldhuisen DJ, Steinseifer J, Noe J, Lauer S, et al. Role of troponins I and T and N-terminal prohormone of brain natriuretic peptide in monitoring cardiac safety of patients with early-stage human epidermal growth factor receptor 2–positive breast cancer receiving trastuzumab: a herceptin adjuvant study cardiac marker substudy. J Clin Oncol. 2016;. doi:10.1200/JCO.2015.65.7916.PubMedGoogle Scholar
  3. 3.
    Beer LA, Kossenkov AV, Liu Q, Luning Prak E, Domchek S, Speicher DW, Ky B. Baseline immunoglobulin E levels as a marker of doxorubicin- and trastuzumab-associated cardiac dysfunction. Circ Res. 2016;119:1135–44.CrossRefPubMedGoogle Scholar

Copyright information

© The Japanese Breast Cancer Society 2017

Authors and Affiliations

  1. 1.MKA Breast Cancer ClinicCankayaTurkey

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