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Chemotherapy with trastuzumab increases risk for HF
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Women with breast cancer who underwent treatment with chemotherapy and trastuzumab had an increased risk for late HF compared with those treated with chemotherapy alone, according to a study published in JACC: Heart Failure.
“This increased risk should be taken into account when planning the course of follow-up after cancer treatment and should be kept in mind when determining the cause of HF or cardiomyopathy in long-term cancer survivors,” Ann Banke, MD, a researcher from the department of cardiology at Odense University Hospital in Denmark, and colleagues wrote.
Researchers analyzed data from 8,812 women with unilateral nonmetastatic breast cancer who underwent surgery. The women were scheduled to undergo chemotherapy (n = 6,695; mean age, 51 years) or chemotherapy with trastuzumab (Herceptin, Genentech; n = 2,117; mean age, 54 years) if they were HER2-positive.
The primary endpoint was a diagnosis of HF, which consisted mainly of systolic HF. Follow-up was conducted from surgery to the first occurrence of the primary endpoint, death, emigration or Dec. 31, 2015, whichever came first.
During a median follow-up of 5.4 years, 2.8% of women in the chemotherapy with trastuzumab group and 0.8% of those in the chemotherapy-only group developed HF, which equated to an incidence rate of 5.3 per 1,000 patient-years (95% CI, 4.1-6.8) and 1.4 per 1,000 patient-years (95% CI, 1.1-1.8), respectively.
Compared with chemotherapy alone, women who underwent treatment with chemotherapy and trastuzumab had a high cumulative incidence of HF both in the short term (HR = 8.7; 95% CI, 4.6-16.5) and long term (HR = 1.9; 95% CI, 1.2-3.3).
“When HF or symptoms of HF are diagnosed, it is important for the patient to provide detailed information about previous cancer treatment when determining the cause, and keeping in mind that trastuzumab, even several years after treatment, could be a contributing factor,” Banke and colleagues wrote.
“A novel finding of this study is increased long-term risk of HF in patients who received chemotherapy and trastuzumab that persists in survivorship, but with low incidence,” Ana Barac, MD, PhD, associate professor of medicine at Georgetown University and director of the cardio-oncology program at MedStar Heart and Vascular Institute in Washington, D.C., wrote in a related editorial. “The American Society of Clinical Oncology Guidelines on Cardiac Dysfunction recommend a single echocardiogram within 1 year of completion of this regimen, an approach that may help identify patients with asymptomatic decreases in LVEF and who may be at risk for clinical HF event. Adherence to this recommendation is low and points to the importance of increasing awareness of cardiac risks in breast cancer survivors in the oncology community.” – by Darlene Dobkowski
Disclosures: The authors and Barac report no relevant financial disclosures.
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