Chemotherapy-Related Cardiotoxicity in Women With Breast Cancer
Posted: Friday, September 14, 2018
Although cardiotoxicity is not a common complication of breast cancer treatment, a study published in JACC: Cardiovascular Imaging suggested that patients treated with trastuzumab or anthracyclines may be at increased risk for heart failure. These findings also indicated that the risk seems to increase consistently with age and that high-risk patients treated with trastuzumab should undergo cardiac monitoring.
“We must remember that while cardiac monitoring is recommended in different guidelines, such recommendations are not based on category 1 data, and the timing recommended and the intervals of testing are rather arbitrary,” Mariana L. Henry, MD, MSC, of The University of Texas MD Anderson Cancer Center, and colleagues noted. “In examining the rate of both cardiac monitoring and cardiotoxicity, we could begin to address the controversial issue of whether cardiac monitoring is warranted in young breast cancer patients.”
The study included 16,456 patients with nonmetastatic invasive breast cancer who were treated with chemotherapy within 6 months of their cancer diagnosis. Of them, 4,325 were treated with trastuzumab-based chemotherapy.
More patients treated with trastuzumab-based chemotherapy developed heart failure than did those who did not receive trastuzumab (8.3% vs. 2.7%; P < .001). Among the women who received trastuzumab, 46.2% underwent guideline-adherent cardiac monitoring—before treatment initiation and every 3 months while on treatment. The authors suggested several reasons for the low rates of cardiac monitoring, such as a low perceived need among physicians.
