Management of cardiac health in trastuzumab-treated patients with breast cancer: updated United Kingdom National Cancer Research Institute recommendations for monitoring

• Published in: British journal of cancer Vol. 100; no. 5; pp. 684 - 692
• Main Authors: JONES, A. L, BARLOW, M, BARRETT-LEE, P. J, CANNEY, P. A, GILMOUR, I. M, ROBB, S. D, PLUMMER, C. J, WARDLEY, A. M, VERRILL, M. W
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 10.03.2009
• Subjects: Algorithms; Antibodies, Monoclonal - adverse effects; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized; Antineoplastic Agents - adverse effects; Antineoplastic Agents - therapeutic use; Biological and medical sciences; Breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - physiopathology; Cancer research; Cancer therapies; Cardiac function; Cardiology; Chemotherapy; Clinical medicine; Clinical Study; Cytotoxicity; Female; Gynecology. Andrology. Obstetrics; Health Planning Guidelines; Heart - physiopathology; Heart Diseases - etiology; Heart Diseases - prevention & control; Heart failure; Heart Failure - chemically induced; Heart Failure - physiopathology; Hospitals; Humans; Mammary gland diseases; Medical research; Medical sciences; Metastasis; Monitoring, Physiologic - methods; Oncology; Patient safety; Toxicity; Trastuzumab; Tumors; United Kingdom; Ventricular Function, Left - drug effects; Womens health; United Kingdom; Europe; United Kingdom > UK; Antineoplastic agent; Heart; Breast disease; Health; Cardiovascular disease; Breast cancer; Monoclonal antibody; Malignant tumor; Research; monitoring; recommendations; Recommendation; Mammary gland diseases; Cancerology; Clinical management; Treatment; Surveillance; UK; Circulatory system; Trastuzumab; Cancer; cardiac
• ISSN: 0007-0920; 1532-1827
• DOI: 10.1038/sj.bjc.6604909

More women are living with and surviving breast cancer, because of improvements in breast cancer care. Trastuzumab (Herceptin) has significantly improved outcomes for women with HER2-positive tumours. Concerns about the cardiac effects of trastuzumab (which fundamentally differ from the permanent myocyte loss associated with anthracyclines) led to the development of cardiac guidelines for adjuvant trials, which are used to monitor patient safety in clinical practice. Clinical experience has shown that the trial protocols are not truly applicable to the breast cancer population as a whole, and exclude some women from receiving trastuzumab, even though they might benefit from treatment without long-term adverse cardiac sequelae. Consequently, five oncologists who recruited patients to trastuzumab trials, some cardiologists with whom they work, and a cardiovascular lead general practitioner reviewed the current cardiac guidelines in the light of recent safety data and their experience with adjuvant trastuzumab. The group devised recommendations that promote proactive pharmacological management of cardiac function in trastuzumab-treated patients, and that apply to all patients who are likely to receive standard cytotoxic chemotherapy. Key recommendations include: a monitoring schedule that assesses baseline and on-treatment cardiac function and potentially reduces the overall number of assessments required; intervention strategies with cardiovascular medication to improve cardiac status before, during, and after treatment; simplified rules for starting, interrupting and discontinuing trastuzumab; and a multidisciplinary approach to breast cancer care.