I. Krstić1, M. Deljanin-Ilić1,2, I. Pejčić2,3, S. Vrbić2,3, D. Marinković1 and M. Stojanović1

Author information

1Institute for Treatment and Rehabilitation Niška Banja, Niš, Serbia;
2Faculty of Medicine, Niš University, Niš, Serbia;
3Clinic of Oncology, University Clinical Center Niš, Niš, Serbia

Abstract

Background: Aside from the clinical benefits of trastuzumab in treating HER2- positive breast cancer, cardiotoxicity is identified as a major side effect. Cardiac function should be closely monitored before, during, and after trastuzumab therapy.
Aim: To assess cardiac function during trastuzumab therapy and the effect of risk factors (RF) for cardiotoxicity and cardiovascular (CV) diseases in HER2-positive breast cancer patients.
Materials and Methods: Ninety-six HER2-positive female breast cancer patients (mean age, 59.57±9.6 years) were enrolled in the study. At the time, they were on sequential therapy with anthracyclines (IV to VI cycles) within the FAC regimen (fluorouracil 500 mg/m2, doxorubicin 50 mg/m2, cyclophosphamide 500 mg/m2) applied per 21 days, and after that, trastuzumab therapy (6 mg/kg of body weight, per 21 days for one year). In all patients, blood pressure (BP), heart rate (HR), electrocardiographic and echocardiographic parameters (left ventricular ejection fraction – LVEF (%), fractional shortening – FS (%), end-diastolic diameter – EDD (mm), and left ventricular mass – LVM (g)) were assessed at the beginning and after the therapy with trastuzumab.
Results: There were no significant changes in arterial BP before and after trastuzumab in the examined patients. Ectopic beats (EB) were registered during the therapy in 11 patients, supraventricular in 7, and ventricular extrasystoles in 4 patients on the electrocardiogram (ECG). In most of the patients with EB in the middle of the treatment period with trastuzumab, sinus tachycardia was also recorded. At the end of trastuzumab therapy in the examined group, LVEF decreased by 1.73 %, FS by 0.86 %, EDD increased by 1.26 mm, and LVM increased by 9.6 g. Cardiotoxicity was registered in 4 (4.17%) patients. Greater left ventricular dysfunction was observed in older patients, patients with prior radiation therapy, and those with three or more cardiovascular risk factors (CVRF).
Conclusion: This study shows that the treatment with trastuzumab does not significantly affect BP and ECG changes. The rate of cardiotoxicity after trastuzumab therapy was low and was expressed through reduction of LVEF, an increase in EDD, and LVM. In patients with three or more CVRFs, there
was a higher decrease of LVEF than in patients without any cardiovascular risk factors.

Keywords:

cardiotoxicity, echocardiographic parameters, risk factors, trastuzumab

Publication type

Journal Article

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