Breast cancer: can trastuzumab be continued after LVEF decline to <50%?

  • Hussain Y & al.
  • Breast Cancer Res Treat
  • 5 Feb 2019

  • curated by Miriam Davis, PhD
  • Univadis Clinical Summaries
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Takeaway

  • 61% of patients who continue to take trastuzumab despite asymptomatic left ventricular ejection fraction (LVEF) decline to
  • 13% developed a cardiac event.

Why this matters

  • First study to examine cardiac events associated with continuing to take trastuzumab with LVEF decline to
  • Findings suggest that continuation in such patients may be a promising approach that warrants more systematic study.

Study design

  • Retrospective cohort of 60 patients identified from an echocardiogram database.
  • Continuation group (n=23) continued trastuzumab with LVEF
  • Interruption group (n=37) included patients who stopped trastuzumab until LVEF improved to ≥50% or permanently discontinued treatment.
  • Funding: NIH.

Key results

  • Continuation group:
    • 61% had no cardiac events.
    • 26% developed worsening LVEF (range, 25%-42%), resulting in trastuzumab discontinuation.
    • 13% had a cardiac event (n=1 HF [New York Heart Association class III-IV]; n=2 possible/probable cardiovascular death).
  • Interruption group:
    • 41% were given trastuzumab after LVEF improved to >50%.
    • 57% were not restarted on trastuzumab.
    • 3% developed HF but no cardiovascular deaths.
  • No difference between groups in LVEF after median follow-up of 633 days (54% in the continuation group vs 56%; P=.29).

Limitations

  • Few patients.
  • Single-center study.