Left Ventricular Dysfunction in Breast Cancer Patients Receiving Trastuzumab: An Observational Study in a Cohort of Iraqi Breast Cancer Patients
Keywords:Breast cancer, Ejection fraction, Trastuzumab
Background : Cardiotoxicity is a well recognized adverse event of trastuzumab. This study was designed to evaluate the frequency of decline in left ventricular ejection fraction (LVEF) to less than 50% in patients with breast cancer who have received trastuzumab in a daily practice setting.
Methods : Retrospective observational study of 116 patients with HER2 positive breast cancer treated with trastuzumab in one center between May 2012 and January 2017.
Results : Left ventricular ejection fraction decline to less than 50% was observed in 7 patients (6%). Patients above 70 years of age have the highest frequency of LVEF decline (33%). All events of LVEF decline was reported in the first six months of treatment. Prolonged administration of trastuzumab beyond one year was not associated with adverse cardiac events. Previous anthracycline exposure and chest irradiation was not found to be associated with LVEF decline.
Conclusions : Events of LVEF decline to less than 50% associated with trastuzumab use seems to be slightly higher in general daily practice than in clinical trial setting, especially in patients above 70 years, calling for better patient selection. First year of trastuzumab therapy carries the highest risk of cardiac events which necessitates a close cardiac monitoring, thereafter, periodic LVEF measurements can be reduced to reduce the costs.
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