Abstract PS10-58: Cost effectiveness of routine cardiac imaging during adjuvant trastuzumab in HER2-positive breast cancer

Abstract

Abstract Background: Guidelines recommend patients treated with trastuzumab (TRA) undergo a multiple gated-acquisition (MUGA) scan or echocardiogram (ECHO) at baseline and every 3 months thereafter. In this retrospective study, we evaluated the incidence of clinically significant cardiotoxicity and analyzed cost effectiveness of routine cardiac imaging during adjuvant TRA. Methods: HER2-positive breast cancer patients treated with adjuvant TRA between 2015 and 2019 were investigated. Information regarding comorbidities, clinical diagnosis of cardiotoxicity, and alterations in therapy were collected. ECHO and MUGA scans were reviewed to monitor trends in ejection fractions (EF). Data was analyzed via the FREQ procedure. We defined clinically significant cardiotoxicity as holding or discontinuing TRA regimen. Results: We found 108 patients. Median age was 57 years (interquartile range (IQR) of 47-68 years); 86% Caucasian and 12% African American. 3% had preexisting heart failure, 43% hypertension, 14% diabetes, 4% coronary artery diseases, 32% hyperlipidemia, 2% chronic kidney disease, 6% stroke, and 38% were smokers. No patients received anthracycline containing regimens. 30 patients (27.7%) had EF drop >10% from baseline. Six patients (5.5%) were identified with clinically significant cardiotoxicity; 4 (3.7%) had EF < 50% and 3 of those 4 were symptomatic (2.7% of total). Median time from initiation to decline in EF > 10% was 6 months (IQR of 4.5-7.5 months). Conclusions: Current practice for TRA cardiotoxicity monitoring consists of cardiac imaging every 3 months. The average cost for a MUGA scan and ECHO is approximately $3700 and $2500, respectively. We determined that clinically significant cardiotoxicity, occurred in 5.5% of the patients approximately 6 months into treatment. With TRA causing reversible cardiotoxicity and 2.7% of the patients being symptomatic, cardiac imaging every 3 months appears excessive, especially in patients without comorbidities. Baseline cardiac imaging with repeat assessment in 6 months appears sufficient in non-anthracycline containing regimen. This strategy allows cost savings of approximately $6000 per patient. Characteristics of patients with clinical cardiotoxicityClinically Significant Cardiotoxicity (N=6)StageChemotherapy RegimenHeart Failure SymptomsEF drop below 50%Initiation to Drop in EF >10% (months)Discontinuation to Recovery in EF (months)1IIBTCHPNoNo3.21.12IATCHPYesYes6.12.83IIATCHNoNo9.31.34IBTCHYesYes6.54.85IIATHYesYes6.12.66IIATCHPNoYes6.31.2 Citation Format: Vineeth Tatineni, Daniel Redle, Daljeet Singh, Arifa Abid, Sameer Mahesh. Cost effectiveness of routine cardiac imaging during adjuvant trastuzumab in HER2-positive breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS10-58.