Risk factors for trastuzumab cardiotoxicity

Risk factors for trastuzumab cardiotoxicity

Trastuzumab cardiotoxicity: Trastuzumab is a monoclonal antibody targeting the HER2 (human epidermal growth factor receptor 2) used in the treatment of HER2 positive breast cancer. The drug when used in the treatment of early stage breast cancer, reduces recurrences by half and mortality by one third. But trastuzumab trials have shown severe heart failure or cardiac event rate up to 3.9%.

Important risk factors for cardiotoxicity with trastuzumab treatment as per 2018 AHA scientific statement are age above 50 years, underlying heart disease or hypertension, baseline left ventricular ejection fraction 50-55% or lower and previous anthracycline therapy [1].

A meta-analysis checked the risk factors for trastuzumab induced cardiotoxicity in breast cancer [2]. They evaluated data from 17 articles including 6527 patients. Hypertension, diabetes, previous anthracycline therapy and older age were the significant risk factors associated with trastuzumab induced cardiotoxicity.

Another meta-analysis published in 2021 checked the relation between conventional cardiac risk factors and trastuzumab induced cardiotoxicity [3]. They included 35 studies and found that age, hypertension, smoking, diabetes mellitus and family history of coronary artery disease were associated with the development of trastuzumab induced cardiotoxicity. Known history of coronary artery disease was also significantly associated with development of trastuzumab induced cardiotoxicity.

References

1. Laxmi S. Mehta, Karol E. Watson, Ana Barac, Theresa M. Beckie, Vera Bittner, Salvador Cruz-Flores, Susan Dent, Lavanya Kondapalli, Bonnie Ky, Tochukwu Okwuosa, Ileana L. Piña, Annabelle Santos Volgman and On behalf of the American Heart Association Cardiovascular Disease in Women and Special Populations Committee of the Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; and Council on Quality of Care and Outcomes Research. Cardiovascular Disease and Breast Cancer: Where These Entities Intersect: A Scientific Statement From the American Heart Association. Circulation. 2018;137:e30-e66.
2. Jawa Z, Perez RM, Garlie L, Singh M, Qamar R, Khandheria BK, Jahangir A, Shi Y. Risk factors of trastuzumab-induced cardiotoxicity in breast cancer: A meta-analysis. Medicine (Baltimore). 2016 Nov;95(44):e5195.
3. Koulaouzidis G, Yung AE, Yung DE, Skonieczna-Żydecka K, Marlicz W, Koulaouzidis A, Charisopoulou D. Conventional cardiac risk factors associated with trastuzumab-induced cardiotoxicity in breast cancer: Systematic review and meta-analysis. Curr Probl Cancer. 2021 Mar 6:100723.