Evaluation of risk factors associated with Trastuzumab-induced Cardiotoxicity in HER-2 positive breast cancer patients

Abstract

Trastuzumab has led to a significant improvement in the treatment of both advanced and early breast cancer that over-expresses HER2 receptors. However, the detection of trastuzumab induced cardiotoxicity (TIC) may compromise its use and should be monitored closely. To assess risk factors associated with the development of cardiotoxicity in patients with HER2-positive breast cancer. We conducted a prospective observational study from June 2018 to December 2019 in the cardio-oncology unit of Casablanca, Morocco. TIC was defined by a decrease in the LVEF of > 10% to a value below the lower limit of normal of 50%, symptomatic of not, after trastuzumab administration. Out of the 413 patients included in our study, 29 (7.0%) developed TIC and 8 of them (1.9%) were symptomatic. After a bivariate analysis, we identified dyslipidemia (P = 0.05), menopause (P = 0.09) and obesity (P = 0.18) as the main cardiovascular risk factors associated with cardiotoxicity in patients with HER2+ breast cancer. Moreover, 24% of patients with TIC suffered underlying cardiovascular diseases. In a multivariate analysis we also identified concomitant anthracycline chemotherapy (P < 0.001) and radiotherapy with a total cumulative dose> 40 Gy. Breast cancer patients with history of cardiovascular disease and with a high cardiovascular risk and risk factors related to the chemotherapy and/or the radiotherapy received with the trastuzumab treatment, have an increased incidence of cardiotoxicity, hence the importance of a close monitoring and follow-up of these patients and an early initiation of cardioprotective treatment.