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10-01-2009, 08:27 PM
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#1
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Senior Member
Join Date: Mar 2006
Posts: 4,778
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New figures (from one cancer center) of incidence of cardiomyopathy from herceptin
much higher than reported from the clinical trials, earlier reports--
J Card Fail. 2009 Oct;15(8):651-7. Epub 2009 Jun 27. Links
Trastuzumab-induced cardiomyopathy: not as benign as it looks? A retrospective study.
Guglin M, Hartlage G, Reynolds C, Chen R, Patel V.
University of South Florida, Tampa, FL 33618, USA. mguglin@health.usf.edu
BACKGROUND: One of the recent advances in the treatment of breast cancer is trastuzumab. However, a major side effect of this medication is cardiomyopathy. Our objective was to determine the incidence of trastuzumab-induced cardiomyopathy and the rate of discontinuation of trastuzumab in a clinical setting. METHODS AND RESULTS: We retrospectively reviewed the records of all women treated with trastuzumab at the Moffitt Cancer Center between 2003 and 2007. Cardiomyopathy was defined as symptomatic heart failure or a decrease of ejection fraction by >or=10% from baseline or to <50%. Statistical analysis was done with Fisher exact test, t-test test, and Wilcoxon signed rank test. Cardiomyopathy developed in 52 of 156 (33.3%) of patients being treated with trastuzumab. In the adjuvant group, 23 (19.5%) of women permanently or temporarily discontinued therapy secondary to cardiomyopathy. CONCLUSIONS: Cardiomyopathy is a common side effect of trastuzumab that leads to discontinuation of treatment in a significant proportion of patients. Further studies are indicated to establish the ways to predict, prevent, and treat cardiomyopathy to provide patients with maximal therapeutic benefit of trastuzumab.
PMID: 19786253
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10-02-2009, 06:29 AM
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#2
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Senior Member
Join Date: Aug 2006
Posts: 3,380
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Re: New figures (from one cancer center) of incidence of cardiomyopathy from hercepti
Interesting, but this is a retrospective study covering all patients treated, which would include early stage and stage IV patients, who no doubt had a lot of chemo. Also, given the time frame, many likely had the original regimen of herceptin + AC, which was later demonstrated to be especially hard on the heart. Hard to tell what the take away from this would be.
Hopeful
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10-02-2009, 08:40 PM
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#3
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Senior Member
Join Date: Mar 2006
Posts: 4,778
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Re: New figures (from one cancer center) of incidence of cardiomyopathy from hercepti
they did differentiate the rate of cardiomyopathy in those treated adjuvantly (19.5%) vs all those treated for ie those treated adjuvantly AND those treated for metastatic disease (33% of ALL patients treated).
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10-02-2009, 10:33 PM
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#4
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Senior Member
Join Date: Nov 2004
Location: Misty woods of WA State
Posts: 4,128
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Re: New figures (from one cancer center) of incidence of cardiomyopathy from hercepti
Thanks, Lani. ALL the numbers here are cause of pause, but what can we do about it now?
I hope these figures will be used in revised warnings, if they ever do such things.
__________________
"When I hear music, I fear no danger. I am invulnerable. I see no foe. I am related to the earliest times, and to the latest." H.D. Thoreau
Live in the moment.
MY STORY SO FAR ~~~~
Found suspicious lump 9/2000
Lumpectomy, then node dissection and port placement
Stage IIB, 8 pos nodes of 18, Grade 3, ER & PR -
Adriamycin 12 weekly, taxotere 4 rounds
36 rads - very little burning
3 mos after rads liver full of tumors, Stage IV Jan 2002, one spot on sternum
Weekly Taxol, Navelbine, Herceptin for 27 rounds to NED!
2003 & 2004 no active disease - 3 weekly Herceptin + Zometa
Jan 2005 two mets to brain - Gamma Knife on Jan 18
All clear until treated cerebellum spot showing activity on Jan 2006 brain MRI & brain PET
Brain surgery on Feb 9, 2006 - no cancer, 100% radiation necrosis - tumor was still dying
Continue as NED while on Herceptin & quarterly Zometa
Fall-2006 - off Zometa - watching one small brain spot (scar?)
2007 - spot/scar in brain stable - finished anticoagulation therapy for clot along my port-a-catheter - 3 angioplasties to unblock vena cava
2008 - Brain and body still NED! Port removed and scans in Dec.
Dec 2008 - stop Herceptin - Vaccine Trial at U of W begun in Oct. of 2011
STILL NED everywhere in Feb 2014 - on wing & prayer
7/14 - Started twice yearly Zometa for my bones
Jan. 2015 checkup still shows NED
2015 Neuropathy in feet - otherwise all OK - still NED.
Same news for 2016 and all of 2017.
Nov of 2017 - had small skin cancer removed from my face. Will have Zometa end of Jan. 2018.
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10-03-2009, 12:11 AM
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#5
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Senior Member
Join Date: Aug 2008
Posts: 327
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Re: New figures (from one cancer center) of incidence of cardiomyopathy from hercepti
This is concerning.
I have had consistent echocardiograms of 70% LVEF function which is great, after 16 herceptins.
Does the cardiomyopathy develop during herceptin use, or months after herceptin has been stopped?
Dianne
__________________
Three years and 5 months NED
Dx: Aug 2008 right breast IDC with 50% of tumor DCIS, Stage II or IIA, tumor size: 2.1 cm
Grade 3
8/9 Richardson/Bloom test
ER+ weakly positive
Alred Score: 4 (suggesting I would strongly benefit from hormone therapy)
PR-,
HER2 positive +++
No vascular invasion
No lymph nodes involved
Surgery: Sept. 9, 2008 -Modified radical mastectomy, right breast. I chose to have a simple mastectomy on the left. Began Taxotere/Carboplatin/Herceptin November, 2008. Finished T/C March 2009. Finished #16 Herceptin Sept. 09. AI's and Tamoxifen made me sick. Began natural Tamoxifen which is Quercetin, I3C and a combo of other supplements. I am also a DES Daughter. There is now a link between DES exposure in utero and breast cancer!
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10-03-2009, 07:16 AM
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#6
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Senior Member
Join Date: Dec 2007
Location: Avilla, Indiana
Posts: 261
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Re: New figures (from one cancer center) of incidence of cardiomyopathy from hercepti
Dianne,
I do not know the answer to your question. But my last MUGA scan was six months after my last Herceptin infusion. It was fine so my onco said I would not need another MUGA. I suspect that heart function is followed for a brief time after Herceptin.
__________________
-Dana-
]
Diagnosed - Nov. 2, 2007 at 45
Lumpectomy - Nov. 13, 2007
Tumor 1.2 cm
Stage 1 Grade 3
ER/PR - Her2 +++ (3.8)
Taxotere/Carboplatin/Herceptin- 6 rounds
Neulasta
Radiation 33 treatments - will be done 6/6/08
Herceptin through 12/08
12/07 MUGA 61%, 4/08 MUGA 60%, 7/08 MUGA 64%
three wonderful daughters, a terrific husband,
Life is Good
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10-03-2009, 09:05 AM
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#7
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Senior Member
Join Date: Apr 2006
Location: Wilmington, Del.
Posts: 1,126
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Re: New figures (from one cancer center) of incidence of cardiomyopathy from hercepti
I only got 36 weeks of Herceptin because my Muga score declined 16%. Doctor advised not going for a full year. I think he stopped me because I was Stage I. My friend had the same oncology team as I did and was Stage 3. Her muga score declined to 43 but they still kept her going for a whole year. Both of us have had echocardiograms since, and we're fine. The cardiologist told me that, in his experience, serious damage from Herceptin shows up within a year.
__________________
MJO
IDC, Stage I, Grade 2
Oncotype DX Score 32
Her2++ E+P+, Node Neg.
Lumpectomy 11/04/05 Clear Margins
3 Dose dense AC (Couldn't tolerate 4)
4 Dose dense Taxol & Herc. (Tolerated well)
36 weeks Herceptin (Could not complete one year due to decrease in MUGA score)
2 years of Arimidex, then three years of Femara
Finished Femara May 2011
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10-03-2009, 10:39 AM
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#8
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Senior Member
Join Date: Mar 2006
Posts: 4,778
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Re: New figures (from one cancer center) of incidence of cardiomyopathy from hercepti
rather than relying on anecdote, there are several good articles on cardiac side-effects of herceptin following large numbers of patients with MUGAs and/or echos and following their response to treatment of the cardiac abnormality/or none . I am enroute today so may not be able to post them now, but as I recall one was by Sharon Hunt and Melinda Telli of Stanford but if you go to PubMed and enter herceptin cardiac or herceptin cardiomyopathy I think you will find a few. Until later...
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10-03-2009, 10:44 AM
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#9
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Senior Member
Join Date: Mar 2006
Posts: 4,778
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Re: New figures (from one cancer center) of incidence of cardiomyopathy from hercepti
Just popping in "herceptin cardiotoxicity" into PubMed I get 198 articles
Nice to know they are not ignoring it!
actually some of the articles that come up are for sorafenib and other targeted agents, so don't fret
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10-03-2009, 05:51 PM
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#10
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Senior Member
Join Date: Jan 2007
Posts: 73
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Re: New figures (from one cancer center) of incidence of cardiomyopathy from hercepti
I hope that oncologists become more aware of this side effect as was not the case with mine. I think anyone who received a/c chemo and or herceptin should be seen by a cardiologist and followed regularly to head off any problems before they become harder to deal with. I am still glad I was able to get herceptin but it is not a drug without side effects as some doctors would have you believe.
__________________
Diagnosed 11/06 IDC left breast Stage 1, High Grade w/extensive High Grade DCIS. Right breast extensive hyperplasia w/calcifications.
ER-/PR- HER2+++
Bi-lateral masectomy 12/15/06 w/expanders
SNB Node Negative
Chemo Taxotere, Cytoxan 2/07-4/07
Herceptin Started 5/07
Exchange surgery 6/15/07
Herceptin stopped after 12 rounds due to herceptin induced cardiomyopathy
On heart meds 'til?
Age 40 at diagnosis
Cancer may have been a defining moment but it does not define me!
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