Background: Trastuzumab (T) has been demonstrated to improve disease-free and overall survival in HER2/neu positive BC. Cardiotoxicity is the most important T-related side effect. We report a single center experience on cardiotoxicity in elderly BC pts treated with T. Patients and methods: Since January 2006 to December 2009, 23 pts with ‡ 65 years (yrs), median age of 70,3 yrs, received T (6 mg/kg day 1 q 21) in adjuvant or metastatic setting. Cardiac function, defined as LVEF, was evaluated at baseline and every 12 weeks (wks) by echocardiogram controls. Pts with baseline LVEF ‡55% were eligible to treatment. Cardiac endpoints were: significant LVEF drop (>10% from baseline), symptomatic severe congestive heart failure (CHF) or cardiac death. Results: A median of 16,3 cycles of T were administered. 10 pts received anthracyclines (A) before T. No severe CHF or cardiac deaths were observed. At wk 12, 10/23 pts (43,5%) had a decreased LVEF from baseline. 5 out of these pts (21,7%) had a significant LVEF drop. No differences were found between pts with > or £ 10% LVEF drop in terms of median baseline LVEF (64,4% vs 60,8%) and median age (68,8 yrs). Median number of T cycles was 10,4 vs 18,2 in pts with or without significant LVEF drop. Among pts with >10% LVEF drop, 3 had been pre-treated with A and 2 had hypertension. Between those who experienced a significant LVEF drop at 12 wks, 4 pts had a > 50% LVEF and maintained T with stable LVEF values at further echocardiograms; only 1 pt had a < 50% LVEF (45%) and discontinuated T, without further cardiac function recovery. Conclusions: A clinically significant unrecovered LVEF drop requiring treatment discontinuation was a rare event in elderly pts treated with T, while an early asymptomatic LVEF drop was more frequently observed. T cardiotoxicity seems not related to age, baseline LVEF, comorbidities, number of T administrations and A pretreatment. On the other hand, LVEF <50% at 12 wks appears to indicate a trastuzumab-related cardiotoxicity, in terms of unrecovered LVEF at further evaluations. Given the limited number of pts, our observation may serve as an hypothesis generating for further investigations.

Left ventricular ejection fraction drop at 12 weeks in elderly breast cancer patients treated with transtuzumab is meaningful for a further unrecovered cardiotoxicity / A., Palazzo; P., Trenta; Iacovelli, Roberto; Mancini, M. L.; A., Pellegrino; B., Cimadon; Mezi, Silvia. - In: ANNALS OF ONCOLOGY. - ISSN 0923-7534. - 21:(2010), pp. 45-45. ((Intervento presentato al convegno impakt breast cancer conference tenutosi a bruxelles nel 6-8 maggio.

Left ventricular ejection fraction drop at 12 weeks in elderly breast cancer patients treated with transtuzumab is meaningful for a further unrecovered cardiotoxicity

IACOVELLI, ROBERTO;MEZI, Silvia
2010

Abstract

Background: Trastuzumab (T) has been demonstrated to improve disease-free and overall survival in HER2/neu positive BC. Cardiotoxicity is the most important T-related side effect. We report a single center experience on cardiotoxicity in elderly BC pts treated with T. Patients and methods: Since January 2006 to December 2009, 23 pts with ‡ 65 years (yrs), median age of 70,3 yrs, received T (6 mg/kg day 1 q 21) in adjuvant or metastatic setting. Cardiac function, defined as LVEF, was evaluated at baseline and every 12 weeks (wks) by echocardiogram controls. Pts with baseline LVEF ‡55% were eligible to treatment. Cardiac endpoints were: significant LVEF drop (>10% from baseline), symptomatic severe congestive heart failure (CHF) or cardiac death. Results: A median of 16,3 cycles of T were administered. 10 pts received anthracyclines (A) before T. No severe CHF or cardiac deaths were observed. At wk 12, 10/23 pts (43,5%) had a decreased LVEF from baseline. 5 out of these pts (21,7%) had a significant LVEF drop. No differences were found between pts with > or £ 10% LVEF drop in terms of median baseline LVEF (64,4% vs 60,8%) and median age (68,8 yrs). Median number of T cycles was 10,4 vs 18,2 in pts with or without significant LVEF drop. Among pts with >10% LVEF drop, 3 had been pre-treated with A and 2 had hypertension. Between those who experienced a significant LVEF drop at 12 wks, 4 pts had a > 50% LVEF and maintained T with stable LVEF values at further echocardiograms; only 1 pt had a < 50% LVEF (45%) and discontinuated T, without further cardiac function recovery. Conclusions: A clinically significant unrecovered LVEF drop requiring treatment discontinuation was a rare event in elderly pts treated with T, while an early asymptomatic LVEF drop was more frequently observed. T cardiotoxicity seems not related to age, baseline LVEF, comorbidities, number of T administrations and A pretreatment. On the other hand, LVEF <50% at 12 wks appears to indicate a trastuzumab-related cardiotoxicity, in terms of unrecovered LVEF at further evaluations. Given the limited number of pts, our observation may serve as an hypothesis generating for further investigations.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/211901
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