Delta NT-proBNP predicts cardiotoxicity in HER2-positive breast cancer patients treated with trastuzumab.

• Overall survival has improved significantly in patients with human epidermal growth receptor 2 (HER2)-positive breast cancer due to the use of the monoclonal antibody trastuzumab blocking HER2. However, patients may develop trastuzumab-induced cardiotoxicity (TIC) leading to congestive heart failure. Here we assessed whether analysing NT-proBNP and assessment of electrocardiography (ECG) could detect TIC during trastuzumab therapy.One hundred thirty-six patients undergoing adjuvant, neoadjuvant or palliative chemotherapy and HER2 blockade for HER2-positive breast cancer were prospectively assessed with echocardiography, ECG and N-terminal - pro hormone B-type natriuretic peptide (NT-proBNP) testing at baseline and at 6 and 12months of trastuzumab therapy. TIC was defined as a left ventricular ejection fraction (LVEF) of less than 50% and a decline from baseline of ≥10 units.Six patients developed TIC under 12months of trastuzumab therapy (incidence 4.4%). NT-proBNP increased from 198.8±64.0pg/ml to 678.7±132.4pg/ml (p<.05) in TIC patients. With a cut-off point of 276.5pg/ml for NTproBNP and increase in NT-proBNP by 75.8pg/ml from baseline the sensitivity was 100% and the specificity 95% to detect TIC. Compared with controls, TIC patients were older (68.3±1.1years and 56.2±1.4years, respectively; p<.01), had more often diabetes mellitus (OR = 63.5, 95% CI: 5.63-915, p<.01) and atrial fibrillation (OR = 12.3; 95% CI: 1.89-74.62; p<.05) and had lower baseline LVEF (57.1±1.4% and 61.4±0.3%, respectively; p<.001). Abnormal ECGs were common in patients developing TIC.Measuring changes in NTproBNP may be used to monitor patients for TIC under trastuzumab therapy. Patients with a cardiovascular risk profile are more at risk of developing TIC.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Cancer och onkologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cancer and Oncology (hsv//eng)

Keyword

oncology

cancer

onkologi

Publication and Content Type

ref (subject category)

art (subject category)