The Anti Her 2 drugs (AH2D): Trastuzumab (T) and Pertuzumab (P), are very important tool in the treatment of HER2 + Breast Cancer. (BC), who presented left ventricular dysfunction (LVD) in the follow-up. We analysed prospectively a group of p. who presented a LVD after the therapy with an AH2D. We proposed that the early treatment with Beta-Blockers (BB) (Carvedilol), angiotensin-converting enzyme inhibitor (IECA) (Enalapril) or Angiotensin Receptor Blockers (ARBs) (Valsartan), Aldosterone Antagonist (AA) (eplerenone); could to help for an early recovery of left ventricular ejection fraction (LVEF) and to allow the reintroduction of the AH2D without a new risk of LVD.
We analysed 593 consecutive p. with HER2 + BC who received T. alone or with P. from January 2017 to August 2018 with Anthracyclines (A) before or not . Basal LVEF evaluation was made by ultrasonography (US) before to start the oncological treatment. 40 p. developed LV dysfunction with the AH2D. All of the 40 p. started treatment with BB, IECA or ARBs, abd AA at the moment of the diagnosis of HF and kept going it after the recovery of LVEF. The reintroduction of the AH2D was when the patients recovered their LVEF. They were followed-up with LVEF by US at 30 days, 60 days and 3 months. We used the SPSS for the statistical analysis.
40 p. aged 53 +/- 7, 100% female. Risk Factors: Arterial Hypertension 8 p., Diabetes 4 p, Dyslipemia 5 p., Cigarettes 7 p. Previous oncological therapies: A. - Ciclophosphamide 20 p., Paclitaxel 20 p. Median of the basal LVEF was 60 % and at the moment of de diagnosis of HF was 41% New York Heart Association (NYHA) class I 15 %, II 60% and III 25%.All of the p. left the AH2D. HF treatment: Carvedilol 39 p., Enalapril 30 patients, Valsartan 9 p. and Eplerenone 40 p. In the follow-up 80% of p. presented the recovery of LVEF at 30 days and 95% at 60 days. When the p. recovered the LVEF we restarted the AH2D. In the follow-up at 3 months none p. had a new LVD and NYHA class I 30%, II 25% and asymptomatic 45%.
While the LVD related with AH2D is a real problem that threat the treatment of patients with Breast Cancer, a timely diagnosis and a treatment with therapies for HF to allow the LVEF recovery and to keep going with the specific oncological therapy.
Andrés J. Daniele.
Has not received any funding.
All authors have declared no conflicts of interest.