Evaluation of cardiac safety of trastuzumab treatment in patients with HER2-positive tumors

Abstract

Objective To evaluate the cardiac safety of trastuzumab-containing regimens in patients with HER2-positive tumors. Methods The clinical data of adult patients with HER2-positive breast cancer, gastric cancer or gastroesophageal junction adenocarcinoma, with normal electrocardiogram and echocardiography before treatments, and treated with trastuzumab-containing regimens in Zhongshan Hospital Affiliated to Fudan University from January 2016 to February 2018 were collected through the hospital information system and cardiac adverse events after trastuzumab-containing regimens were retrospectively analyzed., The patients were divided into 4 groups according to the application history of antineoplastic drugs: group A (neither anthracyclines nor fluoropyrimidines application history), group B (only anthracyclines application history), group C (only fluoropyrimidines application history), and group D (both anthracyclines and fluoropyrimidines application history). The occurrences of cardiac adverse events in the 4 groups were compared. Results A total of 90 patients were enrolled, including 34 males and 56 females, aged (60±12) years. Of them, 43 patients (47.8%) were with breast cancer, 46 (51.1%) were with gastric cancer, and 1 (1.1%) was with gastroesophageal junction adenocarcinoma. Group A, B, C, and D comprised 11, 20, 52, and 7 patients, respectively. Of the 90 patients, 65 patients developed 96 cases of adverse cardiac events. The incidence of adverse cardiac events was 72.2%. The severity of cardiac adverse events was grade 1 in 91 cases and grade 2 in 5 cases. The adverse events with higher incidence were arrhythmia (36.7%, 33/90), abnormal cardiac structure (22.2%, 20/90), valvular reflux (22.2%, 20/90), and increased pulmonary arterial systolic pressure (10.0%, 9/90). There was no significant difference in the incidence of cardiac adverse events after trastuzumab treatment in patients with different antineoplastic drug application history among the 4 groups (all P>0.05). Except for 2 patients with grade 2 sinus tachycardia whose heart rate returned to normal after treatment with beta-blocker, the other 63 patients did not need medical intervention. Conclusion The incidence of cardiac adverse events of trastuzumab treatment in patients with HER2-positive tumors was higher, but the severity of most of them were grade 1, which rarely cause serious cardiac functional or structural damage. Key words: Receptor, erbB-2; Trastuzumab; Cardiotoxicity; Drug-related side effects and adverse reactions