Cardiovascular sequalae of trastuzumab and anthracycline in long-term survivors of breast cancer

Glen, C. et al. (2023) Cardiovascular sequalae of trastuzumab and anthracycline in long-term survivors of breast cancer. Heart, (doi: 10.1136/heartjnl-2023-323437) (Early Online Publication)

Abstract

Objectives: Long-term follow-up of patients treated with trastuzumab largely focuses on those with reduced left ventricular ejection fraction (LVEF) on treatment completion. This study sought to evaluate the prevalence of cardiovascular risk factors, overt cardiovascular disease and cardiac imaging abnormalities using cardiac magnetic resonance (CMR), in participants with normal LVEF on completion of trastuzumab±anthracycline therapy at least 5 years previously. Methods: Participants with human epidermal growth factor receptor 2-positive breast cancer treated with trastuzumab±anthracycline ≥5 years previously were identified from a clinical database. All participants had normal LVEF prior to, and on completion of, treatment. Participants underwent clinical cardiovascular evaluation, ECG, cardiac biomarker evaluation and CMR. Left ventricular systolic dysfunction (LVSD) was defined as LVEF <50%. Results: Forty participants were recruited between 15 March 2021 and 19 July 2022. Median time since completion of trastuzumab was 7.8 years (range 5.9–10.8 years) and 90% received prior anthracycline. 25% of participants had LVSD; median LVEF was 55.2% (Q1–Q3, 51.3–61.2). 30% of participants had N-terminal pro-B-type natriuretic peptide >125 pg/mL and 8% had high-sensitivity cardiac troponin T >14 ng/L. 33% of participants had a new finding of hypertension. 58% had total cholesterol >5.0 mmol/L, 43% had triglycerides >1.7 mmol/L and 5% had a new diagnosis of diabetes. Conclusions: The presence of asymptomatic LVSD, abnormal cardiac biomarkers and cardiac risk factors in participants treated with trastuzumab and anthracycline at least 5 years previously is common, even in those with normal LVEF on completion of treatment. Our findings reinforce the relevance of comprehensive evaluation of cardiovascular risk factors following completion of cancer therapy, in addition to LVEF assessment.

• Item Type: Articles
• Additional Information: This study was funded by a Tenovus Scotland grant (S20-08). NNL and CG are supported by an unrestricted grant from Roche Diagnostics, Switzerland. NNL, MCP and CB are supported by a British Heart Foundation Centre of Research Excellence Grant (RE/18/6/34217).
• Keywords: Magnetic Resonance Imaging, drug monitoring.
• Status: Early Online Publication
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Berry, Professor Colin and Stewart, Mr Philip and Hopkins, Mrs Tracey and Petrie, Professor Mark and Glen, Miss Claire and Lang, Professor Ninian and Roditi, Dr Giles and Mangion, Dr Kenneth and MacPherson, Professor Iain and Morrow, Dr Andrew
• Authors: Glen, C., Morrow, A., Roditi, G., Hopkins, T., Macpherson, I., Stewart, P., Petrie, M. C., Berry, C., Epstein, F., Lang, N. N., and Mangion, K.
• College/School: College of Medical Veterinary and Life Sciences > School of Cancer Sciences; College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Heart
• Publisher: BMJ Publishing Group
• ISSN: 1355-6037
• ISSN (Online): 1468-201X
• Published Online: 16 December 2023
• Copyright Holders: Copyright © 2023 The Authors
• First Published: First published in Heart 2023
• Publisher Policy: Reproduced under a Creative Commons licence

Project Code	Award No	Project Name	Principal Investigator	Funder's Name	Funder Ref	Lead Dept
303944		BHF Centre of Excellence	Colin Berry	British Heart Foundation (BHF)	RE/18/6/34217	SCMH - Cardiovascular & Metabolic Health