Cardiac management during adjuvant trastuzumab therapy:: recommendations of the Canadian Trastuzumab Working Group
Cardiac management during adjuvant trastuzumab therapy:: recommendations of the Canadian Trastuzumab Working Group
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DOI：
10.3747/co.2008.199
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发表时间：
2008-02-01
期刊：
影响因子：
2.6
通讯作者：
Verma, S.
中科院分区：
文献类型：
--
作者：
Mackey, J. R.;Clemons, M.;Verma, S.
曲妥珠单抗已被证明是一种有效的治疗乳腺癌的妇女，过表达的人表皮生长因子受体2（HER2）蛋白。在关键转移性乳腺癌试验中，在接受曲妥珠单抗和化疗的女性中观察到心功能不全。在接受曲妥珠单抗联合蒽环类药物治疗的患者中，心功能不全的发生率和严重程度最高。这些发现影响了后续曲妥珠单抗试验的设计，包括心脏效应的前瞻性评估以及心脏监测和管理方案。心脏毒性的风险也促使人们努力为HER2阳性乳腺癌女性患者开发非蒽环类药物治疗方案，随着曲妥珠单抗的使用越来越多，特别是在辅助治疗方面，显然需要一种合理的方法来治疗和管理相关患者人群的心脏。加拿大曲妥珠单抗工作组的任务是根据现有数据制定建议，以评估和管理曲妥珠单抗辅助治疗期间的心脏并发症。该小组在四个方面提出了建议：心脏毒性的风险因素各种方案的影响治疗管理随着更多数据的可用和曲妥珠单抗在辅助治疗中的经验的增加，这里发表的建议预计会不断发展。
Trastuzumab has been shown to be an effective therapy for women with breast cancer that overexpresses the human epidermal growth factor receptor 2 (HER2) protein. In the pivotal metastatic breast cancer trials, cardiac dysfunction was observed in women treated with trastuzumab and chemotherapy. The incidence and severity of cardiac dysfunction was greatest among patients who received trastuzumab in combination with anthracycline-based therapy. Those findings influenced the design of subsequent trastuzumab trials to include prospective evaluations of cardiac effects and protocols for cardiac monitoring and management. The risk of cardiotoxicity has also driven efforts to develop non-anthracycline-based regimens for women with HER2-positive breast cancers.With the increasing use of trastuzumab, particularly in the curative adjuvant setting, the need for a rational approach to the treatment and cardiac management of the relevant patient population is clear. The mandate of the Canadian Trastuzumab Working Group was to formulate recommendations, based on available data, for the assessment and management of cardiac complications during adjuvant trastuzumab therapy. The panel formulated recommendations in four areas:Risk factors for cardiotoxicityEffects of various regimensMonitoringManagementThe recommendations published here are expected to evolve as more data become available and experience with trastuzumab in the adjuvant setting grows.