While concerns about trastuzumab-related cardiac dysfunction (TRCD) in patients with breast cancer (BRCA) increasing, there is a lack of evidences to support current recommendation to monitor TRCD. Especially, in Asian population, clinical manifestations and predictors of TRCD were unknown. Therefore, we aimed to identify characteristics and predictors of TRCD in Asian patients with BRCA.
From 2003 to 2016, consecutive 1371 patients who treated with adjuvant trastuzumab for BRCA were enrolled. We excluded patients with metastatic BRCA, number of trastuzumab administration <3 times, or without serial echocardiographic data. TRCD was defined as decrease > 10% in left ventricular ejection fraction (LVEF), with a decline below the normal limit value (50%). Median follow-up duration was 54.2 months.
Of 787 patients evaluated (mean age, 50.3±9.5 years), 58 (7.4%) were developed TRCD (median time to develop TRCD, 6.1 [3.1-7.9] months) and most of them (75.9%) were improved from TRCD after 5.7 (3.5-17.7) months. TRCD patients had higher baseline blood pressure (SBP, mmHg; 125 [107-136] vs 114 [104-126], p = 0.005 and DBP, mmHg; 72 [65-81] vs 68 [61-76], p = 0.004), lower initial LVEF (63 [59-66] % vs 65 [61-68] %, p = 0.016) and more frequently administered anthracycline (98% vs 89%, p = 0.022). Cumulative dose of anthracycline was also higher in those with TRCD (404 [374-458] mg vs 372 [336-400] mg, p < 0.001). There were no differences in concurrent radiotherapy, cancer location/stage and previous history of cardiovascular disease between two groups. On follow-up echocardiography, EF drop >5% within 3 months regardless of absolute LVEF value was more frequent in TRCD patients (78.3% vs 38.4%, p < 0.001). In multivariate analysis, EF drop>5% within 3 months from trastuzumab administration was significantly associated with development of TRCD (HR, 45.1[17.0-127.6], p < 0.001) as well as baseline LVEF and cumulative dose of anthracycline.
Asian BRCA patients received adjuvant trastuzumab were relatively young and less frequently developed TRCD compared to Western data. LVEF drop >5% within 3 months from trastuzumab administration was a strong predictor of TRCD.
Yeon Hee Park
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All authors have declared no conflicts of interest.