An evaluation of the safety of continuing trastuzumab despite overt left ventricular dysfunction
An evaluation of the safety of continuing trastuzumab despite overt left ventricular dysfunction
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DOI：
10.3747/co.26.4631
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发表时间：
2019-08-01
期刊：
影响因子：
2.6
通讯作者：
Leong, D. P.
中科院分区：
文献类型：
--
作者：
Barron, C. C.;Alhussein, M. M.;Leong, D. P.
背景曲妥珠单抗治疗的主要局限性是心脏毒性。我们评估了乳腺癌患者持续使用曲妥珠单抗治疗策略的安全性，尽管患者存在轻度、无症状的左心室损害。方法2015年1月至2017年3月因左心室射血分数（LvEr）下降（定义为下降10个百分点或更多）而转介至心脏肿瘤诊所的连续患者的图表，或曲妥珠单抗治疗期间小于50%的值。关注的主要结果是左室射血分数（LVEF）的变化，在曲妥珠单抗暴露前和暴露期间测量，在开始心脏药物治疗后最多3次，中位时间为9 months.Results。所有18例LVEF下降的患者均选择继续使用曲妥珠单抗，并被纳入研究。所有患者均接受血管紧张素转换酶抑制剂或β受体阻滞剂治疗，或两者兼而有之。开始心脏药物治疗后，LVEF随时间增加4.6个百分点（95%置信区间：1.9个百分点至7.4个百分点），接近基线值。在18例患者中，17例（94%）在所有未来访视时均无症状。没有死亡发生在group.Conclusions许多患者轻度降低LVEF和最小的心力衰竭症状可能能够继续曲妥珠单抗没有进一步下降LVEF，不良心脏事件，或死亡时，在心脏病专家的监督下进行治疗密切随访。
Background The major limitation in the use of trastuzumab therapy is cardiotoxicity. We evaluated the safety of a strategy of continuing trastuzumab in patients with breast cancer despite mild, asymptomatic left ventricular impairment.Methods Charts of consecutive patients referred to a cardio-oncology clinic from January 2015 to March 2017 for decline in left ventricular ejection fraction (LvEr), defined as a fall of 10 percentage points or more, or a value of less than 50% during trastuzumab therapy, were reviewed. The primary outcome of interest was change in LVEF, measured before and during trastuzumab exposure and up to 3 times after initiation of cardiac medications during a median of 9 months.Results All 18 patients referred for decline in LVEF chose to remain on trastuzumab and were included. All patients were treated with angiotensin converting-enzyme inhibitors or beta-blockers, or both. After initiation of cardiac medications, LVEF increased over time by 4.6 percentage points (95% confidence interval: 1.9 percentage points to 7.4 percentage points), approaching baseline values. Of the 18 patients, 17 (94%) were asymptomatic at all future visits. No deaths occurred in the group.Conclusions Many patients with mildly reduced LVEF and minimal heart failure symptoms might be able to continue trastuzumab without further decline in LVEF, adverse cardiac events, or death when treated under the supervision of a cardiologist with close follow-up.