Cardiovascular sequelae of trastuzumab and anthracycline in long-term survivors of breast cancer

• Published in: Heart (British Cardiac Society) Vol. 110; no. 9; pp. 650 - 656
• Main Authors: Glen, Claire, Morrow, Andrew, Roditi, Giles, Hopkins, Tracey, Macpherson, Iain, Stewart, Philip, Petrie, Mark C, Berry, Colin, Epstein, Fred, Lang, Ninian N, Mangion, Kenneth
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and British Cardiovascular Society 16.12.2023; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Asymptomatic; Biomarkers; Blood pressure; Breast cancer; Cancer therapies; Cardiology; Cardiotoxicity; Cardiovascular disease; Drug dosages; Drug Monitoring; Graft versus host disease; Health services; Heart failure; Hypertension; Magnetic Resonance Imaging; Patients; Radiation therapy; Risk assessment; Risk factors; Software; Special Populations; Surveillance; Toxicity; Womens health; Basel Switzerland; Switzerland; Drug Monitoring; Magnetic Resonance Imaging
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/heartjnl-2023-323437

ObjectivesLong-term follow-up of patients treated with trastuzumab largely focuses on those with reduced left ventricular ejection fraction (LVEF) on treatment completion. This study sought to evaluate the prevalence of cardiovascular risk factors, overt cardiovascular disease and cardiac imaging abnormalities using cardiac magnetic resonance (CMR), in participants with normal LVEF on completion of trastuzumab±anthracycline therapy at least 5 years previously.MethodsParticipants with human epidermal growth factor receptor 2-positive breast cancer treated with trastuzumab±anthracycline ≥5 years previously were identified from a clinical database. All participants had normal LVEF prior to, and on completion of, treatment. Participants underwent clinical cardiovascular evaluation, ECG, cardiac biomarker evaluation and CMR. Left ventricular systolic dysfunction (LVSD) was defined as LVEF <50%.ResultsForty participants were recruited between 15 March 2021 and 19 July 2022. Median time since completion of trastuzumab was 7.8 years (range 5.9–10.8 years) and 90% received prior anthracycline. 25% of participants had LVSD; median LVEF was 55.2% (Q1–Q3, 51.3–61.2). 30% of participants had N-terminal pro-B-type natriuretic peptide >125 pg/mL and 8% had high-sensitivity cardiac troponin T >14 ng/L. 33% of participants had a new finding of hypertension. 58% had total cholesterol >5.0 mmol/L, 43% had triglycerides >1.7 mmol/L and 5% had a new diagnosis of diabetes.ConclusionsThe presence of asymptomatic LVSD, abnormal cardiac biomarkers and cardiac risk factors in participants treated with trastuzumab and anthracycline at least 5 years previously is common, even in those with normal LVEF on completion of treatment. Our findings reinforce the relevance of comprehensive evaluation of cardiovascular risk factors following completion of cancer therapy, in addition to LVEF assessment.