report of (asymptomatic) cardiac dysfunction with antiher2 vaccine used vs DCIS

[Lani]

The question is always is the treatment worse than the disease--balancing the risk/possible benefit equation.

If the trial had been with herceptin, it could always have been stopped.

I don't think anyone knows how long the anti-her2 immune response from this vaccine will last

That said, there have been a lot of antiher2 vaccine trials, and I think this is the first report of cardiac dysfunciton associated with them. Do most trials insist on periodic MUGAs/Ultrasounds?

And remember, these patients were not treated with anthracyclines or other chemotherapies and I doubt they got Left sided radiation therapy(will try to check the article)

Am J Surg. 2009 Oct;198(4):488-94.
Asymptomatic changes in cardiac function can occur in ductal carcinoma-in-situ patients following treatment with HER-2/neu-pulsed dendritic cell vaccines.
Bahl S, Roses RE, Sharma A, Koldovsky U, Xu S, Weinstein S, Nisenbaum H, Fox K, Pasha T, Zhang P, Araujo L, Carver J, Czerniecki BJ.

Department of Surgery, Rena Rowan Breast Center, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA.
Abstract
BACKGROUND: Targeting HER-2/neu with Trastuzumab has been associated with development of cardiac toxicity.

METHODS: Twenty-seven patients with ductal carcinoma in situ (DCIS) of the breast completed an IRB approved clinical trial of a HER-2/neu targeted dendritic cell based vaccine. Four weekly vaccinations were administered prior to surgical resection. All subjects underwent pre- and post-vaccine cardiac monitoring by MUGA/ECHO scanning allowing for a comparison of cardiac function.

RESULTS: In 3 of 27 vaccinated patients (11%) transient asymptomatic decrements in ejection fraction of greater than 15% were noted after vaccination. Notably, evidence of circulating anti-HER-2/neu antibody was found prior to vaccination in all three patients, but cardiac toxicity was not noted until induction of cellular mediated immune responses.

CONCLUSIONS: This is the first description of HER-2/neu targeted vaccination associated with an incidence of cardiac changes, and the induction of cellular immune responses combined with antibody may contribute to changes in cardiac function.

PMID: 19800453