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Cardiotoxicity Surveillance and Risk of Heart Failure During HER2 Targeted Therapy

BACKGROUND: Guidelines recommend left ventricular ejection fraction (LVEF) assessments every 3 months for cardiotoxicity monitoring during human epidermal growth factor receptor 2 (HER2) targeted therapy. Evidence in support of this practice is lacking. OBJECTIVES: This study examines the associatio...

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Autores principales: Yu, Anthony F., Moskowitz, Chaya S., Lee Chuy, Katherine, Yang, Ji, Dang, Chau T., Liu, Jennifer E., Oeffinger, Kevin C., Steingart, Richard M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7584138/
https://www.ncbi.nlm.nih.gov/pubmed/33103123
http://dx.doi.org/10.1016/j.jaccao.2020.03.002
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author Yu, Anthony F.
Moskowitz, Chaya S.
Lee Chuy, Katherine
Yang, Ji
Dang, Chau T.
Liu, Jennifer E.
Oeffinger, Kevin C.
Steingart, Richard M.
author_facet Yu, Anthony F.
Moskowitz, Chaya S.
Lee Chuy, Katherine
Yang, Ji
Dang, Chau T.
Liu, Jennifer E.
Oeffinger, Kevin C.
Steingart, Richard M.
author_sort Yu, Anthony F.
collection PubMed
description BACKGROUND: Guidelines recommend left ventricular ejection fraction (LVEF) assessments every 3 months for cardiotoxicity monitoring during human epidermal growth factor receptor 2 (HER2) targeted therapy. Evidence in support of this practice is lacking. OBJECTIVES: This study examines the association between adherence to cardiotoxicity surveillance guidelines and heart failure (HF) in HER2-positive breast cancer patients. METHODS: A case-control study was performed in 53 patients who developed cardiotoxicity during HER2 targeted therapy, and 159 controls matched by age, anthracycline exposure, and year of treatment. Cardiotoxicity was defined as HF (New York Heart Association functional class III or IV) or cardiac death. Adherence to cardiotoxicity surveillance guidelines was ascertained from the beginning of HER2 targeted therapy to the diagnosis date of HF for cases or the corresponding timepoint for matched controls. Conditional logistic regression was used for case-control comparisons. RESULTS: Eighty-one percent of cases and controls were previously treated with an anthracycline. Adherence to cardiotoxicity surveillance guidelines during the entire observation period or during the first 6 months of treatment was not associated with lower risk of HF. An LVEF <55% at any surveillance timepoint was identified in 49% of cases and 3% of controls, and an LVEF <55% during the final surveillance timepoint before developing HF was identified in 54% of cases and 4% of controls. In multivariable-adjusted analyses, LVEF <55% at any timepoint or during the final surveillance timepoint (odds ratio: 27.0; 95% confidence interval: 9.3 to 78.8 and odds ratio: 25.6; 95% confidence interval: 7.3 to 90.3, respectively) was associated with HF. CONCLUSIONS: Patients with LVEF <55% on routine surveillance during HER2 targeted therapy are at increased risk for HF. Additional studies to define their optimal management are warranted.
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spelling pubmed-75841382020-10-23 Cardiotoxicity Surveillance and Risk of Heart Failure During HER2 Targeted Therapy Yu, Anthony F. Moskowitz, Chaya S. Lee Chuy, Katherine Yang, Ji Dang, Chau T. Liu, Jennifer E. Oeffinger, Kevin C. Steingart, Richard M. JACC CardioOncol Original Research BACKGROUND: Guidelines recommend left ventricular ejection fraction (LVEF) assessments every 3 months for cardiotoxicity monitoring during human epidermal growth factor receptor 2 (HER2) targeted therapy. Evidence in support of this practice is lacking. OBJECTIVES: This study examines the association between adherence to cardiotoxicity surveillance guidelines and heart failure (HF) in HER2-positive breast cancer patients. METHODS: A case-control study was performed in 53 patients who developed cardiotoxicity during HER2 targeted therapy, and 159 controls matched by age, anthracycline exposure, and year of treatment. Cardiotoxicity was defined as HF (New York Heart Association functional class III or IV) or cardiac death. Adherence to cardiotoxicity surveillance guidelines was ascertained from the beginning of HER2 targeted therapy to the diagnosis date of HF for cases or the corresponding timepoint for matched controls. Conditional logistic regression was used for case-control comparisons. RESULTS: Eighty-one percent of cases and controls were previously treated with an anthracycline. Adherence to cardiotoxicity surveillance guidelines during the entire observation period or during the first 6 months of treatment was not associated with lower risk of HF. An LVEF <55% at any surveillance timepoint was identified in 49% of cases and 3% of controls, and an LVEF <55% during the final surveillance timepoint before developing HF was identified in 54% of cases and 4% of controls. In multivariable-adjusted analyses, LVEF <55% at any timepoint or during the final surveillance timepoint (odds ratio: 27.0; 95% confidence interval: 9.3 to 78.8 and odds ratio: 25.6; 95% confidence interval: 7.3 to 90.3, respectively) was associated with HF. CONCLUSIONS: Patients with LVEF <55% on routine surveillance during HER2 targeted therapy are at increased risk for HF. Additional studies to define their optimal management are warranted. Elsevier 2020-06-16 /pmc/articles/PMC7584138/ /pubmed/33103123 http://dx.doi.org/10.1016/j.jaccao.2020.03.002 Text en © 2020 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Research
Yu, Anthony F.
Moskowitz, Chaya S.
Lee Chuy, Katherine
Yang, Ji
Dang, Chau T.
Liu, Jennifer E.
Oeffinger, Kevin C.
Steingart, Richard M.
Cardiotoxicity Surveillance and Risk of Heart Failure During HER2 Targeted Therapy
title Cardiotoxicity Surveillance and Risk of Heart Failure During HER2 Targeted Therapy
title_full Cardiotoxicity Surveillance and Risk of Heart Failure During HER2 Targeted Therapy
title_fullStr Cardiotoxicity Surveillance and Risk of Heart Failure During HER2 Targeted Therapy
title_full_unstemmed Cardiotoxicity Surveillance and Risk of Heart Failure During HER2 Targeted Therapy
title_short Cardiotoxicity Surveillance and Risk of Heart Failure During HER2 Targeted Therapy
title_sort cardiotoxicity surveillance and risk of heart failure during her2 targeted therapy
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7584138/
https://www.ncbi.nlm.nih.gov/pubmed/33103123
http://dx.doi.org/10.1016/j.jaccao.2020.03.002
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