An Evaluation of the Safety of Continuing Trastuzumab Despite Overt Left Ventricular Dysfunction
| Autor: | Mark Brown, U Kaur, Darryl P. Leong, Nidhi Kumar Tyagi, Muhammad Mustafa Alhussein, Som D. Mukherjee, Tammy Cosman, Sukhbinder Dhesy-Thind, Carly C. Barron, Peter M. Ellis |
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| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
cardio-oncology her2 Receptor ErbB-2 Adrenergic beta-Antagonists cardiotoxicity Angiotensin-Converting Enzyme Inhibitors Breast Neoplasms Asymptomatic Ventricular Function Left Ventricular Dysfunction Left 03 medical and health sciences Breast cancer 0302 clinical medicine Trastuzumab Internal medicine Humans Medicine In patient cardiovascular diseases 030212 general & internal medicine skin and connective tissue diseases neoplasms Aged Retrospective Studies Cardiotoxicity Ejection fraction business.industry Middle Aged medicine.disease Survival Analysis Confidence interval Treatment Outcome 030220 oncology & carcinogenesis Heart failure cardiovascular system Cardiology Female Original Article medicine.symptom business medicine.drug |
| Zdroj: | Current Oncology Volume 26 Issue 4 Pages 4631-246 |
| ISSN: | 1718-7729 |
| DOI: | 10.3747/co.26.4631 |
| Popis: | The major limitation in the use of trastuzumab therapy is cardiotoxicity. We evaluated the safety of a strategy of continuing trastuzumab in patients with breast cancer despite mild, asymptomatic left ventricular impairment. Charts of consecutive patients referred to a cardio-oncology clinic from January 2015 to March 2017 for decline in left ventricular ejection fraction (lvef), defined as a fall of 10 percentage points or more, or a value of less than 50% during trastuzumab therapy, were reviewed. The primary outcome of interest was change in lvef, measured before and during trastuzumab exposure and up to 3 times after initiation of cardiac medications during a median of 9 months. All 18 patients referred for decline in lvef chose to remain on trastuzumab and were included. All patients were treated with angiotensin converting&ndash enzyme inhibitors or beta-blockers, or both. After initiation of cardiac medications, lvef increased over time by 4.6 percentage points (95% confidence interval: 1.9 percentage points to 7.4 percentage points), approaching baseline values. Of the 18 patients, 17 (94%) were asymptomatic at all future visits. No deaths occurred in the group. Many patients with mildly reduced lvef and minimal heart failure symptoms might be able to continue trastuzumab without further decline in lvef, adverse cardiac events, or death when treated under the supervision of a cardiologist with close follow-up. |
| Databáze: | OpenAIRE |
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