Cardiac Management During Adjuvant Trastuzumab Therapy: Recommendations of the Canadian Trastuzumab Working Group

摘要

Trastuzumab has been shown to be an effective therapy for women with breast cancer that over-expresses the HER2 protein. In the pivotal metastatic breast cancer trials, cardiac dysfunction was observed in women treated with trastuzumab and chemotherapy. The incidence and severity of cardiac dysfunction was greatest among patients who received trastuzumab in combination with anthracycline-based therapy. These findings influenced the design of subsequent trastuzumab trials to include prospective evaluations of cardiac effects, as well as cardiac monitoring and management protocols. The risk of cardiotoxicity has also driven efforts to develop non-anthracycline based regimens for women with HER2-positive breast cancers. As the use of trastuzumab increases, particularly in the curative adjuvant setting, there is a clear need for a rational approach to treatment and cardiac management of these patients. The mandate of the Canadian Trastuzumab Working Group was to formulate recommendations for assessment and management of cardiac complications during adjuvant trastuzumab therapy, based on available data. The panel formulated recommendations in four areas: risk factors for cardiotoxicity; impact of different regimens; monitoring; and management. It is expected that these recommendations will evolve as more data becomes available and experience with trastuzumab in the adjuvant setting grows.