How to Follow, Manage and Treat Cardiac Dysfunction in Patients With Her2+ Breast Cancer.
How to Follow, Manage and Treat Cardiac Dysfunction in Patients With Her2+ Breast Cancer.
复制标题
DOI：
10.1016/j.jaccao.2020.08.010
复制
发表时间：
2020-11
期刊：
影响因子：
--
通讯作者：
Barac A
中科院分区：
文献类型：
--
作者：
Blaes A;Manisty C;Barac A
虽然已知曲妥珠单抗会增加心脏毒性的风险，特别是左心室（LV）功能障碍和/或心力衰竭（HF），但自2000年代以来，使用曲妥珠单抗治疗HER 2+乳腺癌一直是标准治疗方法（1）。在辅助乳腺癌试验中，症状性HF的总体报告发生率为2.5%，而无症状的左心室射血分数（LVEF）下降更常见（1）。美国食品药品监督管理局（FDA）的曲妥珠单抗处方标签（2）建议在治疗期间每3个月进行一次基线和监测LVEF测量，在治疗完成后至少2年内每6个月进行一次扫描，并因LVEF下降至低于正常值和LVEF相对于治疗前值绝对下降> 10%而暂停/停止治疗。然而，对成像的依从性各不相同，并且由于LVEF下降，人们担心早期中断或停止曲妥珠单抗可能会对癌症相关结局产生不利影响（3）。现有的建议主要是基于蒽环类药物和曲妥珠单抗联合治疗转移性疾病患者的高心脏毒性风险证据，以及随后的曲妥珠单抗辅助试验设计（包括频繁的LVEF评估）（2）。然而，外推法可能具有误导性，因为病理生理学不同，非蒽环类HER 2治疗的长期数据有限。因此，平衡基于曲妥珠单抗的治疗（停止）与心脏风险仍然是一个挑战，特别是因为建议没有考虑癌症的侵袭性和/或额外的心血管风险。从诊断到癌症治疗和生存的整个护理过程中，都需要与患者、肿瘤学家、心脏病学家和多学科护理团队合作。本文介绍了临床情况，说明了在预防，治疗和随访HER 2+乳腺癌患者的心功能不全的挑战和实用的解决方案。一名55岁的绝经后女性，没有已知的预先存在的心血管（CV）风险因素，被诊断为I期HER 2+乳腺癌。由于没有高风险肿瘤特征（淋巴结阴性，小肿瘤），她的肿瘤学家建议紫杉醇每周一次，持续12周，曲妥珠单抗每3周一次，持续12个月。
While known to increase the risk of cardiotoxicity, particularly left ventricular (LV) dysfunction and/or heart failure (HF), the use of trastuzumab for HER2+ breast cancer has been the standard of care since the 2000s (1). In adjuvant breast cancer trials, the overall reported incidence of symptomatic HF has been 2.5%, while asymptomatic declines in left ventricular ejection fraction (LVEF) occur more commonly (1). The Food and Drug Administration prescription label for trastuzumab (2) recommends baseline and surveillance LVEF measurements every 3 months during treatment, with scans every 6 months for at least 2 years following treatment completion, and holding/stopping therapy for LVEF decline to below normal and> 10% absolute LVEF decrease from pretreatment values. However, compliance with imaging has varied, and concerns have been raised that interrupting or stopping trastuzumab early, due to declines in LVEF, can adversely influence cancer-related outcomes (3). The existing recommendations have been largely informed by the evidence of high cardiotoxicity risk with anthracycline and trastuzumab combination therapy in patients with metastatic disease and the subsequent design of adjuvant trastuzumab trials that incorporated frequent LVEF assessment (2). Extrapolation, however, may be misleading, given differing pathophysiology and limited long-term data with non-anthracycline HER2 therapy. As a result, balancing the (dis) continuation of trastuzumabbased therapy with cardiac risk remains a challenge, particularly as the recommendations do not account for the aggressiveness of the cancer and/or additional cardiovascular risks. Collaboration with the patient, oncologist, cardiologist, and multidisciplinary care team is required across the spectrum of care from diagnosis through cancer treatment and survivorship. This paper presents clinical scenarios that illustrate challenges and practical solutions in the prevention, treatment and follow-up of cardiac dysfunction in patients with HER2+ breast cancer.CASE 1. A 55-year-old postmenopausal woman with no known preexisting cardiovascular (CV) risk factors is diagnosed with a stage I HER2+ breast cancer. With no high-risk tumor features (node negative, small tumor) her oncologist recommends paclitaxel weekly for 12 weeks with trastuzumab every 3 weeks for 12 months.
登录
查看更多内容
影响因子：
45.3
作者：
Armenian, Saro H.;Lacchetti, Christina;Lenihan, Daniel
通讯作者：
Lenihan, Daniel
影响因子：
11.1
作者：
Leong, Darryl P.;Cosman, Tammy;Dhesy-Thind, Sukhbinder
通讯作者：
Dhesy-Thind, Sukhbinder
DOI：
10.6004/jnccn.2017.0044
发表时间：
2017-04-01
影响因子：
13.4
作者：
Gradishar, William J.;Anderson, Benjamin O.;Kumar, Rashmi
通讯作者：
Kumar, Rashmi
影响因子：
3.8
作者：
Lynce, F.;Barac, A.;Swain, S. M.
通讯作者：
Swain, S. M.
影响因子：
28.4
作者：
Dang, Chau;Guo, Hao;Tolaney, Sara M.
通讯作者：
Tolaney, Sara M.