Elderly women with breast cancer and a history of heart
disease are at a particularly higher risk for heart problems when treated with
trastuzumab for their disease, according to data from a recent study.
“Trastuzumab is a current standard of care in
HER2-positive breast cancer patients,” Cesar Serrano, MD, clinical
fellow at the Department of Medical Oncology Breast Cancer Centre at the Vall
d’Hebron University Hospital in Barcelona, Spain, and colleagues wrote in
their study. “Although well tolerated, concerns about cardiotoxicity have
recently led to a push to identify patients at risk of developing
treatment-related cardiac events.”
Serrano and colleagues analyzed data for 45 women aged
70 to 92 years who were treated with trastuzumab (Herceptin, Genentech) since
2005. According to their results, 26.7% of patients developed a
treatment-related cardiac event; 17.8% developed asymptomatic left ventricular
ejection fraction (LVEF) decline; and 8.9% developed symptomatic congestive
heart failure. All patients who developed asymptomatic cardiac events recovered
after treatment discontinuation. All but one patient who developed symptomatic
congestive heart failure recovered in a median of 5 weeks.
Women with CV risk factors, like history of cardiac
disease and diabetes, were more likely to have treatment-related
cardiotoxicity: 33% of those with a history of heart disease vs. 9.1% of those
without (P=.017) and 33.3% of those with diabetes vs. 6.1% of those
without (P=.010).
“Approximately 70% of all newly diagnosed cancers
occur in patients older than 65 and, given the expected increase in the
absolute number of elderly patients over the coming decades in Western
countries, there is an unmet need for information about the efficacy and safety
of anti-cancer treatments in daily clinical practice,” Serrano said in a
press release. “Data obtained in this report can serve to advise
clinicians to be aware of symptomatic and asymptomatic cardiac dysfunction in
elderly patients. We think that it is reasonable to refer elderly breast cancer
patients to a cardiologist if one or more cardiovascular risk factors are
present before or during treatment with trastuzumab. Moreover, a closer
surveillance of early symptoms and cardiac function is highly
recommended.”
Disclosure: The researchers report no relevant disclosures.