Cardiac risk associated with trastuzumab acceptable, data suggest
Patients receiving trastuzumab (Herceptin) therapy for HER-2 positive breast cancer are at risk of developing cardiac toxicity, although for patients with advanced disease this risk may be acceptable, according to US researchers (Journal of Clinical Oncology published
online on 14
August 2006).
Valentina Guarneri and colleagues from the Texas MD Anderson Cancer Centre
found that of 218 women who received trastuzumab for a median of 21.3
months, 49 (28 per cent) suffered from cardiac dysfunction. Cardiac function
in all but three patients improved after discontinuation of trastuzumab
and treatment with beta blockers and angiotensin-converting enzyme inhibitors,
suggesting that the pathological changes induced by therapy are reversible.
After recovery of cardiac function 26 patients were retreated with trastuzumab,
16 of whom did not experience additional cardiac toxicity.
One of the three patients whose cardiac function did not recover despite
standard therapy died.
The researchers observed that the risk for cardiac toxicity among patients
receiving concomitant taxanes was higher early in the follow-up period
and declined over time, whereas the risk among patients who were treated
with trastuzumab alone increased during follow-up. However, because the
study did not assess risk of toxicity for patients treated with a taxane
alone, the researchers were unable to consider whether the combination
is safe compared with a taxane alone.
The study’s senior investigator, Francisco Esteva, said that long-term
use of trastuzumab “appears to be safe” but stressed that
patients should receive a baseline cardiac assessment and then follow
up care from a cardiologist. He added that the results of the study did
not apply to patients with early-stage breast cancer. “Cardiac
toxicity may represent a major concern for such patients,” he said. |
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