Medicine - Xagena

A study in women with advanced breast cancer has found that cardiotoxicity associated with Trastuzumab ( Herceptin ) is reversible and that the therapy can be resumed if no other acceptable treatment options are available.

In the study, the cardiac safety of long-term Trastuzumab therapy in patients with human epidermal growth receptor 2 ( HER2 ) -overexpressing metastatic breast cancer treated at The University of Texas M.D. Anderson Cancer Center.

Among 218 metastatic breast cancer patients treated with Trastuzumab-based therapy for at least 1 year, 173 patients were assessable for cardiac toxicity.

Cardiac events were defined as follows: asymptomatic decrease of left ventricular ejection fraction ( LVEF ) below 50%; decrease of 20 percentage points in LVEF compared with the baseline; or signs or symptoms of congestive heart failure ( CHF ).

The median cumulative time for Trastuzumab administration was 21.3 months. The median follow-up was 32.6 months.

Forty-nine patients ( 28% ) experienced a cardiac events: three patients ( 1.7% ) had an asymptomatic decrease in the LVEF of 20 percentage points, 27 patients ( 15.6% ) experienced grade 2 cardiac toxicity, and 19 patients ( 10.9% ) experienced grade 3 cardiac toxicity.

All but three patients had improved LVEF or symptoms of congestive heart failure with Trastuzumab discontinuation and appropriate therapy.

There was one cardiac-related death ( 0.5% ).

Baseline LVEF was significantly associated with cardiac events ( hazard ratio, 0.94; P = .001 ).
The hazard of a cardiac event among patients taking concomitant taxanes was higher early in the follow-up period but declined during the course of follow-up.

According to authors: “ The risk of cardiac toxicity of long-term Trastuzumab-based therapy is acceptable in this population, and this toxicity is reversible in the majority of the patients. In patients who have experienced a cardiac event, additional treatment with Trastuzumab can be considered after recovery of cardiac function. “

Source: Journal of Clinical Oncology, 2006


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