Cardiac safety of non-anthracycline trastuzumab-based therapy for HER2-positive breast cancer.
Cardiac safety of non-anthracycline trastuzumab-based therapy for HER2-positive breast cancer.
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基于非蒽环类曲妥珠单抗治疗 HER2 阳性乳腺癌的心脏安全性。
DOI：
10.1007/s10549-017-4362-x
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发表时间：
2017
影响因子：
3.8
通讯作者：
Dang,ChauT
中科院分区：
文献类型：
--
作者：
Yu,AnthonyF;Mukku,RoyB;Verma,Shivani;Liu,JenniferE;Oeffinger,KevinC;Steingart,RichardM;Hudis,CliffordA;Dang,ChauT
目的曲妥珠单抗可提高HER 2阳性乳腺癌患者的总生存率，但与心脏毒性相关，尤其是在蒽环类药物治疗后使用。使用非蒽环类曲妥珠单抗为基础的方案正在增加，特别是对于低风险疾病或具有多种心血管风险因素的患者。我们进行了一项单中心回顾性队列研究，以评估在临床试验环境之外不含蒽环类药物的曲妥珠单抗的心脏安全性。方法对接受非蒽环类药物曲妥珠单抗治疗的HER 2阳性早期乳腺癌患者进行了回顾性图表审查2010年1月至2014年6月期间。收集心血管危险因素、左心室射血分数（LVEF）和治疗中断数据。主要结局是心脏事件（CE），由纽约心脏协会定义为III级或IV级心力衰竭或心源性死亡。次要结果是一个显着的无症状的LVEF下降（>10%至<55% or>16%，从基线）。ResultsA共165例患者被确定为中位年龄为59岁（范围32-85岁）。70例（42%）患有高血压，52例（32%）患有高脂血症，29例（18%）患有糖尿病，5例（3%）患有冠状动脉疾病。所有患者基线时LVEF>50%（中位数67%;范围50-80%），2例（1.2%）有多种心血管危险因素的患者发生CE。曲妥珠单抗停药后，这两名患者的LVEF恢复到>50%和解决的心力衰竭symptoms. Ten（6.1%）患者开发显着的无症状的LVEF下降在trastuzumab therapeutic.ConclusionsThe的总发病率有症状的心力衰竭和无症状的LVEF下降曲妥珠单抗治疗患者之间没有蒽环类药物仍然很低。这些结果表明，在不使用蒽环类药物的曲妥珠单抗治疗期间，较低强度的心脏监测可能是适当的。
PurposeTrastuzumab improves overall survival for women with HER2-positive breast cancer but is associated with cardiotoxicity, especially when administered after anthracyclines. Use of non-anthracycline trastuzumab-based regimens is rising, particularly for patients with low-risk disease or with multiple cardiovascular risk factors. We performed a single-center retrospective cohort study to assess the cardiac safety of trastuzumab without anthracyclines outside of a clinical trial setting.MethodsA retrospective chart review was conducted of patients with HER2-positive early-stage breast cancer receiving non-anthracycline trastuzumab-based therapy between January 2010 and June 2014. Cardiovascular risk factors, left ventricular ejection fraction (LVEF), and treatment interruption data were collected. The primary outcome was a cardiac event (CE), defined by New York Heart Association class III or IV heart failure or cardiac death. The secondary outcome was a significant asymptomatic decline of LVEF (>10% to <55% or>16% from baseline).ResultsA total of 165 patients were identified with a median age of 59 years (range 32–85 years). Seventy (42%) had hypertension, 52 (32%) had hyperlipidemia, 29 (18%) had diabetes, and 5 (3%) had coronary artery disease. All patients had a LVEF>50% (median 67%; range 50–80%) at baseline. Two (1.2%) patients with multiple cardiovascular risk factors developed a CE. After discontinuation of trastuzumab, both patients had recovery of LVEF to >50% and resolution of heart failure symptoms. Ten (6.1%) patients developed significant asymptomatic LVEF decline during trastuzumab therapy.ConclusionsThe overall incidence of symptomatic heart failure and asymptomatic LVEF decline among patients receiving trastuzumab without anthracyclines remains low. These findings suggest that less intensive cardiac monitoring may be appropriate during trastuzumab therapy without anthracyclines.
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