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Current Oncology
Volume 26
Issue 4
10.3747/co.26.4631
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Current Oncology is published by MDPI from Volume 28 Issue 1 (2021). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by MDPI on mdpi.com as a courtesy and upon agreement with Multimed Inc..
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Article

An Evaluation of the Safety of Continuing Trastuzumab Despite Overt Left Ventricular Dysfunction

by
C.C. Barron
1,*,
M.M. Alhussein
1,
U. Kaur
2,
T.L. Cosman
3,4,
N.K. Tyagi
5,
M. Brown
3,
S.D. Mukherjee
5,
P.M. Ellis
5,
S. Dhesy-Thind
5 and
D.P. Leong
1,6,7,*
1
Department of Medicine, McMaster University, Hamilton, ON L8L 2X2, Canada
2
Department of Medicine, University of Western Ontario, London, ON N6A 5C1, Canada
3
Hamilton Health Sciences, Juravinski Hospital and Cancer Centre, Hamilton, ON L8N 3M8, Canada
4
School of Nursing, McMaster University, Hamilton, ON L8V 5C2, Canada
5
Department of Oncology, McMaster University, Hamilton, ON L8S 4K1, Canada
6
The Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON L8S 4L8, Canada
7
Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON L8N 4K1, Canada
*
Authors to whom correspondence should be addressed.
Curr. Oncol. 2019, 26(4), 240-246; https://doi.org/10.3747/co.26.4631
Submission received: 1 May 2019 / Revised: 7 June 2019 / Accepted: 8 July 2019 / Published: 1 August 2019

Abstract

Background: The major limitation in the use of trastuzumab therapy is cardiotoxicity. We evaluated the safety of a strategy of continuing trastuzumab in patients with breast cancer despite mild, asymptomatic left ventricular impairment. Methods: Charts of consecutive patients referred to a cardio-oncology clinic from January 2015 to March 2017 for decline in left ventricular ejection fraction (LVEF), defined as a fall of 10 percentage points or more, or a value of less than 50% during trastuzumab therapy, were reviewed. The primary outcome of interest was change in LVEF, measured before and during trastuzumab exposure and up to 3 times after initiation of cardiac medications during a median of 9 months. Results: All 18 patients referred for decline in LVEF chose to remain on trastuzumab and were included. All patients were treated with angiotensin converting–enzyme inhibitors or beta-blockers, or both. After initiation of cardiac medications, LVEF increased over time by 4.6 percentage points (95% confidence interval: 1.9 percentage points to 7.4 percentage points), approaching baseline values. Of the 18 patients, 17 (94%) were asymptomatic at all future visits. No deaths occurred in the group. Conclusions: Many patients with mildly reduced LVEF and minimal heart failure symptoms might be able to continue trastuzumab without further decline in LVEF, adverse cardiac events, or death when treated under the supervision of a cardiologist with close follow-up.
Keywords: Breast cancer; trastuzumab; cardiotoxicity; cardio-oncology; HER2 Breast cancer; trastuzumab; cardiotoxicity; cardio-oncology; HER2

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MDPI and ACS Style

Barron, C.C.; Alhussein, M.M.; Kaur, U.; Cosman, T.L.; Tyagi, N.K.; Brown, M.; Mukherjee, S.D.; Ellis, P.M.; Dhesy-Thind, S.; Leong, D.P. An Evaluation of the Safety of Continuing Trastuzumab Despite Overt Left Ventricular Dysfunction. Curr. Oncol. 2019, 26, 240-246. https://doi.org/10.3747/co.26.4631

AMA Style

Barron CC, Alhussein MM, Kaur U, Cosman TL, Tyagi NK, Brown M, Mukherjee SD, Ellis PM, Dhesy-Thind S, Leong DP. An Evaluation of the Safety of Continuing Trastuzumab Despite Overt Left Ventricular Dysfunction. Current Oncology. 2019; 26(4):240-246. https://doi.org/10.3747/co.26.4631

Chicago/Turabian Style

Barron, C.C., M.M. Alhussein, U. Kaur, T.L. Cosman, N.K. Tyagi, M. Brown, S.D. Mukherjee, P.M. Ellis, S. Dhesy-Thind, and D.P. Leong. 2019. "An Evaluation of the Safety of Continuing Trastuzumab Despite Overt Left Ventricular Dysfunction" Current Oncology 26, no. 4: 240-246. https://doi.org/10.3747/co.26.4631

APA Style

Barron, C. C., Alhussein, M. M., Kaur, U., Cosman, T. L., Tyagi, N. K., Brown, M., Mukherjee, S. D., Ellis, P. M., Dhesy-Thind, S., & Leong, D. P. (2019). An Evaluation of the Safety of Continuing Trastuzumab Despite Overt Left Ventricular Dysfunction. Current Oncology, 26(4), 240-246. https://doi.org/10.3747/co.26.4631

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