In:
Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 31, No. 15_suppl ( 2013-05-20), p. e11558-e11558
Abstract:
e11558 Background: In this study we assessed the cardiotoxic effects of adjuvant trastuzumab in daily practice after its introduction in the Netherlands in 2005. Methods: We included all patients with stage I-III breast cancer diagnosed in the years 2005 to 2007 in 5 hospitals in the South of the Netherlands. We studied guidelines adherence on left ventricular ejection fraction (LVEF) monitoring and the incidence of cardiotoxicity in patients with HER2 positive disease treated with adjuvant trastuzumab, using similar cardiac-endpoints as in prior randomized trials. In addition, we determined predictors of onset of cardiotoxicity. Results: Of 2685 patients included, 494 (18.4%) had a HER2 positive tumor. From these 494, 266 (53.8%) were treated with adjuvant chemotherapy and 228 (85.7%) received trastuzumab. Anthracycline based chemotherapy was given to 218 (96%) patients prior to trastuzumab treatment. LVEF measurements were done in 222 patients (97.4%). Fifty eight patients (25.4%) had ‘symptomatic cardiotoxicity’ during trastuzumab treatment, of whom 43 (18.9%) patients had a drop in LVEF of ≥ 10 percentage points. In 36 (15.8%) patients, cardiotoxicity led to permanent discontinuation of trastuzumab although in 50% LVEF recovered to levels permitting continuation, and in 22 (9.6%) patients treatment was temporary discontinued. No cardiac deaths were seen. The largest drops in LVEF occurred between baseline and the first 3-month assessment. Only 3.1% permanently discontinued treatment ≥ 6 months measurement. Patients with trastuzumab related cardiotoxicity did not show more cardiac comorbidities at baseline (14% vs. 24% p=0.12) and did not receive a higher cumulative dose of anthracyclines (mean 549mg vs. 546mg, p=0.48) than those without trastuzumab related cardiotoxicity. Conclusions: Regarding cardiotoxicity,trastuzumab was cautiously implemented in the Netherlands. In the first years, physicians based their decision to discontinue treatment frequently on patient ‘symptoms’ apart from LVEF outcome. Treatment discontinuation occurred mainly in the first three months after start of trastuzumab. Funding:Netherlands Organization for Health Research and Development and Roche Netherlands.
Type of Medium:
Online Resource
ISSN:
0732-183X
,
1527-7755
DOI:
10.1200/jco.2013.31.15_suppl.e11558
Language:
English
Publisher:
American Society of Clinical Oncology (ASCO)
Publication Date:
2013
detail.hit.zdb_id:
2005181-5
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