WEDNESDAY, Aug. 16 (HealthDay News) -- In women with HER2-positive metastatic breast cancer, trastuzumab can cause cardiac toxicity, which can be reversed with beta-blockers and ACE inhibitors. Additional trastuzumab treatment can be considered after recovery of cardiac function, according to a study published online Aug. 14 in the Journal of Clinical Oncology.
Valentina Guarneri, M.D., of the University of Texas M.D. Anderson Cancer Center in Houston, and colleagues studied 218 patients who received trastuzumab for a median of 21.3 months.
The researchers found that 49 of the patients (28 percent) experienced cardiac events. Of these, three (1.7 percent) had an asymptomatic 20 percent decrease in the left ventricular ejection fraction (LVEF), 27 (15.6 percent) experienced grade 2 cardiac toxicity, 19 (10.9 percent) experienced grade 3 cardiac toxicity and one (0.5 percent) died of cardiac causes. The investigators found that all but three of the surviving patients improved when trastuzumab was discontinued and appropriate therapy was started.
"Careful and frequent monitoring of patients treated with trastuzumab should include history and physical examination in addition to non-invasive imaging of ventricular function," write the authors of an accompanying editorial. "Until additional evidence is accumulated from the randomized trials, we should err on the side of caution in the use of this agent when either clinical or echocardiographic/scintigraphic evidence of heart failure exists or develops."
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