Herceptin and Cardiac Toxicity

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Trastuzumab cardiotoxicity may be reversible

Reuters Health
Posting Date: August 24, 2006



Last Updated: 2006-08-24 16:45:29 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Treatment with trastuzumab for more than 1 year appears to reduce cardiac function and increase the risk of congestive heart failure, physicians report in the Journal of Clinical Oncology for September. However, this toxicity is not dose-dependent and appears to be reversible, therefore not precluding further treatment with the monoclonal antibody.

Trastuzumab (Herceptin) is recommended for women with human epidermal growth receptor 2 (HER-2)-positive breast cancer, either alone or as adjunctive treatment with chemotherapy. Cardiotoxicity is common when trastuzumab is combined with anthracyclines.

To evaluate the effects of trastuzumab-based care outside of clinical trials, Dr. Francisco J. Esteva and colleagues assessed cardiotoxicity among 173 women with metastatic breast cancer positive for HER-2 and treated at the University of Texas M.D. Anderson Cancer Center in Houston for at least 1 year.

A total of 49 (28%) patients experienced a cardiac event, defined as an asymptomatic decrease in left ventricular ejection fraction below 50%, a decrease of 20% in LVEF compared with baseline, or evidence of congestive heart failure.

Among the 15 symptomatic patients, 14 discontinued trastuzumab, and 11 recovered after treatment with a beta-blocker or ACE inhibitor. One patient died after developing congestive heart failure.

To minimize adverse effects, Dr. Esteva and his colleagues recommend that cardiac function be evaluated before starting trastuzumab, especially if the patient has already undergone treatment with an anthracycline.

"The risk of cardiac toxicity of long-term trastuzumab-based therapy is acceptable in this population, and this toxicity is reversible in the majority of the patients," the researchers conclude. "In patients who have experienced a cardiac event, additional treatment with can be considered after recovery of cardiac function."

J Clin Oncol 2006;24.