Published online Jul 26, 2022. doi: 10.4330/wjc.v14.i7.403
Peer-review started: December 23, 2021
First decision: February 15, 2022
Revised: March 29, 2022
Accepted: June 17, 2022
Article in press: June 17, 2022
Published online: July 26, 2022
Processing time: 208 Days and 15 Hours
It remains unclear whether the current arbitrary screening recommendations of trastuzumab-related cardiotoxicity provides an adequate balance between preventing heart damage and curtailing a curative treatment.
To determine the incidence rate and consequences of trastuzumab-induced cardiotoxicity as adjuvant treatment in a real-world scenario.
We present a retrospective analysis of cardiac function measured by echocardiogram at baseline and every 3 mo during trastuzumab treatment. Cardiotoxicity was defined as a drop in left ventricular ejection fraction (LVEF) ≥ 10% from baseline and/or any drop < 50%.
Between January 2011 and December 2014, 407 patients were selected. Most (93.6%) were treated with an anthracycline followed by a taxane-based regimen and trastuzumab for 12 mo. Forty patients (9.8%) had cardiotoxicity. None of them were symptomatic, and 28 (72.5%) completely recovered LVEF. Cardiotoxicity happened early as shown by LVEF measured on echocardiogram 2 to 4 as compared to 5 to 7 (odds ratio = 2.47, 95% confidence interval: 1.09, 5.63, P = 0.024). There were 54 deaths (13.3%) during the 70-mo follow-up period; 1 (0.2%) was attributed to late cardiotoxicity (4 years after treatment). The absence of symptomatic cardiotoxicity during trastuzumab treatment and moreover the early occurrence on the treatment period may translate into a strategy to evaluate less frequently.
We observed a 10% rate of asymptomatic cardiotoxicity, which mirrors the results from the large adjuvant trials. Despite being transient, an LVEF drop led to frequent treatment delays and interruptions. It remains unclear whether LVEF decline is predictive of late cardiotoxicity, and treatment efficacy is compromised.
Core Tip: It remains unclear whether the current arbitrary screening recommendations for trastuzumab-related cardiotoxicity in early-stage HER2-positive breast cancer provides an adequate balance between preventing heart damage and curtailing a curative treatment. Real world data showed that despite a low rate of mainly early, asymptomatic and transient cardiotoxicity, treatment delays and interruptions occur due to these findings. The study results suggest optimization of cardiac monitoring after an initial period without a decrease in cardiac function.