Role of hypertension on new onset congestive heart failure in patients receiving trastuzumab adjuvant chemotherapy for early breast cancer.

Abstract

e11556 Background: Adjuvant trastuzumab therapy improves survival of Human Epidermal growth factor Receptor 2 (HER2)-positive women with early breast cancer (EBC). Trastuzumab-induced cardiotoxicity is not uncommon, occurring prevalently asymptomatic in the first three months of therapy. In the setting of community patients, the incidence, timing and phenotype of new onset congestive heart failure (CHF) is unknown. Methods: 499 consecutive HER2-positive women (mean age 55+11) with EBC treated with Trastuzumab between January 2008 and June 2009 at 10 Italian institutions were followed-up for 1 year. We evaluated incidence, time of occurrence, clinical features associated with CHF. Left ventricular ejection fraction (LVEF) was evaluated by echocardiography at baseline and 3-6-9-12 months during Trastuzumab therapy. Results: CHF occurred in 16 patients (3.2%), who were older and had a higher prevalence and higher degree of hypertension in comparison with patients who had not CHF. All CHF patients had a significant reduction in LVEF with a mean peak of – 12 points % detected at 3-month follow up. CHF occurred in 7 patients (44%) within 3-month follow-up, 4 patients (25%) between 3-6 months, 3 patients (19%) between 6-9 months and 2 patients (12%) between 9-12 months. Trastuzumab was discontinued in 10 of 16 patients and re-started in 5 after LVEF recovery. New onset CHF was predicted by the presence of hypertension (OR 2.9 [CI 1.1 – 7.9]. Conclusions: In clinical practice new onset CHF occurs seldom in HER-positive women with EBC, prevalently in the first six months of therapy. CHF is invariably associated with a significant reduction in LVEF and is predicted by a history of hypertension.