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To the editor,
I want to congratulate Lee and colleagues for their article [1] in which they investigated factors for the time to occur trastuzumab-induced cardiotoxicity. They showed that body mass index ≥ 23 kg/m2, LVEF < 62.5%, and anthracycline-based chemotherapy were associated with time to trastuzumab-induced cardiotoxicity. The authors did not mention other predictive markers for trastuzumab-induced cardiotoxicity. Zardavas et al. [2] explored the prognostic value of cardiac markers to identify patients at increased risk for trastuzumab-induced cardiotoxicity 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 trastuzumab-induced cardiotoxicity. 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. Taken all together, evaluation of baseline serum Ig E and troponin I or T levels in addition to aforementioned cardiac risk factors may clearly identify patients at increased risk for trastuzumab-induced cardiotoxicity.
References
Lee MH, Yee J, Kim YJ, Moon JY, Kim JH, Rhie SJ, Gwak HS. Factors for time to trastuzumab-induced cardiotoxicity in breast cancer patients. Med Oncol. 2017;34:199. https://doi.org/10.1007/s12032-017-1041-z.
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. 2017;35(8):878–84. https://doi.org/10.1200/JCO.2015.65.7916.
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.
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Altundag, K. More predictive markers were identified for trastuzumab-induced cardiotoxicity. Med Oncol 35, 8 (2018). https://doi.org/10.1007/s12032-017-1072-5
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DOI: https://doi.org/10.1007/s12032-017-1072-5