Risk factors of trastuzumab-induced cardiotoxicity in breast cancer: A meta-analysis.
Risk factors of trastuzumab-induced cardiotoxicity in breast cancer: A meta-analysis.
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DOI：
10.1097/md.0000000000005195
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发表时间：
2016-11
期刊：
影响因子：
1.6
通讯作者：
Shi Y
中科院分区：
文献类型：
--
作者：
Jawa Z;Perez RM;Garlie L;Singh M;Qamar R;Khandheria BK;Jahangir A;Shi Y
曲妥珠单抗靶向人表皮生长因子受体2癌基因，结合一线治疗可显著改善生存结果，因此已成为辅助治疗和转移性治疗的标准治疗方法。虽然估计接受曲妥珠单抗治疗的患者中有1%至4%会发生心力衰竭，约10%会出现左心室射血分数（LVEF）降低，但与曲妥珠单抗诱导的心脏毒性（TIC）相关的患者危险因素尚不清楚。本荟萃分析旨在整合先前发表的数据，以确定最有可能导致TIC的风险因素。使用关键词曲妥珠单抗/赫赛汀、危险因素、结局、心脏、心脏毒性、心肌病、LVEF和化疗对MEDLINE文献数据库进行检索。仅纳入前瞻性/回顾性人类研究，如果报告基线LVEF bb0 68%，队列<50例患者或结果未根据心脏毒性事件分层，则排除其他研究。计算每个潜在危险因素的合并优势比（OR）和95%置信区间（CI），并使用随机效应模型探讨数据和样本的异质性。数据收集自17篇文章，共6527例患者。高血压（OR 1.61, 95% CI 1.14-2.26, P < 0.01）、糖尿病（OR 1.62, 95% CI 1.10-2.38, P < 0.02）、既往使用蒽环类药物（OR 2.14, 95% CI 1.17-3.92, P < 0.02）和年龄较大（P = 0.013）均与TIC相关。接受曲妥珠单抗治疗的女性应密切监测心脏功能。认识到潜在的危险因素，并仔细注意症状/LVEF测量，可以最大限度地减少TIC在这一人群中的发生。
Trastuzumab targets the human epidermal growth factor receptor 2 oncogene and in combination with first-line therapy results in significantly improved survival outcomes and has thus become standard of care in both adjuvant and metastatic settings. While it is estimated that 1% to 4% of patients treated with trastuzumab will develop heart failure and ∼10% will experience a reduction in left ventricular ejection fraction (LVEF), the patient risk factors associated with trastuzumab-induced cardiotoxicity (TIC) are unclear. This meta-analysis aims to consolidate previously published data to identify the risk factors most likely leading to TIC. A search of the MEDLINE literature database using the keywords trastuzumab/Herceptin, risk factors, outcomes, cardiac, cardiotoxicity, cardiomyopathy, LVEF, and chemotherapy was performed. Only prospective/retrospective human studies were included, with additional studies excluded if they reported baseline LVEF > 68%, a cohort of <50 patients, or results that were not stratified based on cardiotoxic events. Pooled odds ratio (OR) and 95% confidence interval (CI) for each potential risk factor were calculated, with heterogeneity of data and samples explored using random-effects modeling. Data were collected from 17 articles, capturing 6527 patients. Hypertension (OR 1.61, 95% CI 1.14–2.26; P < 0.01), diabetes (OR 1.62; 95% CI 1.10–2.38; P < 0.02), previous anthracycline use (OR 2.14; 95% CI 1.17–3.92; P < 0.02), and older age (P = 0.013) were all shown to be associated with TIC. Cardiac performance should be closely monitored in women treated with trastuzumab. Recognizing potential risk factors along with careful attention to symptoms/LVEF measurements could minimize the occurrence of TIC in this population.