Cardiac Events and Cardiac Monitoring in Adjuvant Trastuzumab Patients at The Christie: a Retrospective Audit

Abstract

Purpose:Web-based prognostic and predictive tools are used to quantify the risk of relapse, death and absolute benefit of adjuvant chemotherapy. These decision aids include Adjuvant! Online and Predict. Validated genomic tests such as Oncotype DX quantify the individual risk profile using gene expression analysis. We assessed decision-making for adjuvant chemotherapy using Adjuvant! Online in the absence of genomic testing for ‘intermediate’ risk patients. Methods: A retrospective analysis was conducted in patients who underwent curative local breast axillary surgery between 1 April 2014 and 31 March 2015. Evaluable patients were required to have tumours that were ER positive, HER-2 negative (FISH), no lymph node involvement and any grade or size. ‘Intermediate risk’was defined as an absolute overall survival advantage between 3 and 5% at 10 years using the Adjuvant! Online tool. The treatment decision (chemotherapy or no chemotherapy) was documented. Results: 31 patients were identified with a mean age of 57.2 years (range 38e74). The mean age that received chemotherapy was 50.1 versus 61.1 who did not. Tumour size distribution was T1 (35.5%), T2 (61.3%), T3 (3.2%) and T4 (0%); grade 1 (0%), grade 2 (58%), grade 3 (42%). 11 patients (35%) received adjuvant chemotherapy. Patients who received chemotherapy were associated with high grade tumours (70% grade 3). The mean tumour size in the two groups was similar (23.2 mm [chemotherapy] versus 28.4 mm). 73% of patients who accepted adjuvant chemotherapy were quoted an overall projected survival advantage at 10 years of 5% compared with 30% in those who declined treatment. Conclusions: Currently, patients with an estimated 3e5% overall survival benefit by Adjuvant! Online are offered Oncotype DX testing. The majority of ‘intermediate risk’ patients declined adjuvant chemotherapy. Those who accepted treatmentweremore likely to have a benefit of 5% or greater. Future audits will re-evaluate chemotherapy acceptance rates and the cost-effectiveness of genomic assays.