New figures (from one cancer center) of incidence of cardiomyopathy from herceptin

[Lani]

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

[Hopeful]

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

[Lani]

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).

[StephN]

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.

[DianneS]

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

[DanaRT]

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.

[MJo]

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.

[Lani]

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...

[Lani]

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

[Paris]

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.