hot off the press- herceptin cardiotoxicity? not be as reversibleas previouslythought

[Lani]

J Clin Oncol. 2007 Aug 10;25(23):3525-33.
Trastuzumab-related cardiotoxicity: calling into question the concept of reversibility.

Telli ML, Hunt SA, Carlson RW, Guardino AE.
875 Blake Wilbur Dr, Stanford, CA 94305; e-mail: guardino@stanford.edu.
PURPOSE To assess the spectrum and reversibility of the cardiotoxicity observed in the adjuvant trastuzumab trials. Design The design and efficacy of the major adjuvant trastuzumab trials was assessed, including the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-31, North Central Cancer Treatment Group N9831, Herceptin Adjuvant, Breast Cancer International Research Group 006, and Finland Herceptin trials. The cardiotoxicity data were evaluated with a focus on the follow-up cardiac evaluations of women who were diagnosed with cardiotoxicity. Proposed mechanisms of trastuzumab-related cardiotoxicity were considered. The natural history of congestive heart failure (CHF) was reviewed with the goal of placing the trastuzumab experience in context. Results Up to 4% of patients enrolled onto the adjuvant trastuzumab trials experienced severe CHF during treatment. In these trials, early stopping rules that identified an unacceptable level of cardiotoxicity were never reached. Despite this, a large number of patients on these trials experienced some form of cardiotoxicity that ultimately required discontinuation of trastuzumab. Approximately 14% of patients in the NSABP B-31 trial discontinued trastuzumab because of asymptomatic decreases in left ventricular ejection fraction (LVEF). Results of follow-up cardiac evaluations of patients diagnosed with any degree of cardiotoxicity in the NSABP B-31 trial document that a clinically significant proportion of patients have sustained decrements in their LVEF to less than 50%. CONCLUSION Adjuvant trastuzumab provides substantial benefits to patients with human epidermal growth factor receptor 2-positive breast cancer, however, competing immediate and long-term cardiovascular risks are a great concern. Continued cardiac follow-up of these women is of critical importance.
PMID: 17687157 [PubMed - in process]

[TriciaK]

This is an interesting article! Let me add my personal experience for what ever it's worth. I was not in this trial but have had considerable heart problems (Congestive heart failure and cardiomyopathy). As some of you know, I had had BC in 1985, then spine mets in 1990, then was NED for almost 15 years. In 2004 I had a heart attack which literally saved my life, because a CT Scan in prep for heart surgery found that the BC was back, this time her2 er/pr+++ and in my lungs. The heart surgery was postponed while we fought the her2 BC with herceptin and 6 months of navelbine. A MUGA showed 57 LEF about that time. 15 months later the cancer was in remission, but my LEF was between 30 and 35. A succesful triple bypass was done in May,2006. The LEF was about the same until recently. It seems to be slowly rising, now about 43. Am on 5 heart meds and femara, still NED. I made the decision to go on herceptin knowing of the possibility of further heart damage, and would still make the same decision. If the BC mets return I am hoping there is something safer for my heart but as efficient as herceptin. If not, I will consider herceptin again inspite of the possibility of further damage. We do what we have to do! Hugs and prayers for all you Amazon warriors! Tricia

[Becky]

Tricia

It is wonderful to hear from you again and to know that you continue to do so well.

[mamacze]

Lani,
Thank you for another great article; and Triciak,, I love reading your posts. You have such spirit and it is heartwarming to read your story of making tough decisions while still standing strong. Thank you for sharing and I am so glad to read that you are hangin in there.
Love Kim from CT

[harrie]

Can someone tell me how often it is recommended to have your heart checked while on herceptin?
Maryanne

[Chelee]

Maryanne, Most oncologist seem to go with having an ECHO or MUGA every 3 months while on herceptin.

Chelee