Cardiotoxicity with sequential use of Anthracycline and Trastuzumab in carcinoma breast patients in a North Indian tertiary care centre

Abstract

Background: Anthracycline and Trastuzumab containing regimens demonstrate significant efficacy in human epidermal growth factor receptor 2 (HER2) positive breast cancer patients. The utility of this strategy is limited by significant cardiotoxicity associated with these drugs. This study was conducted to study the cardiotoxicity with sequential use of Anthracyclines and Trastuzumab to identify early signs of carditoxicity and tailor therapy for these patients. Materials and Methods: A total of 45 cases of breast cancer patients who expressed HER 2 by immunohistochemistry (IHC) (3+) or fluorescent in situ hybridisation (FISH) were included in this study. The patients were evaluated for cardiotoxicity by clinical examination, echocardiography and Multigated acquisition (MUGA) scan at periodic intervals. Results: Fall in ejection fraction was noticed in 20% of patients. Most of these patients were asymptomatic. Two dimensional echocardiography (2 D Echo) and MUGA scans were complimentary to each other. The fall of ejection fraction was reversible in 89% of these patients on stopping Trastuzumab for median of 6 weeks duration. All these patients completed planned treatment on reintroduction of Trastuzumab. Conclusion: The sequential use of Anthracyclines and Trastuzumab has cardiotoxic potential. Detecting early signs of cardiotoxicity and monitoring asymptomatic fall in ejection fraction can prevent long term cardiotoxic side effects. Due to reversible nature of cardiotoxicity of Trastuzumab, it can be reintroduced in most of the patients. Benefits of Trastuzumab therapy can be achieved by keeping close observation on cardiotoxicity and tailor treatment accordingly.

Keywords

• Anthracycline
• Human epidermal growth factor receptor 2 (HER2)
• left ventricular ejection fraction
• Multigated acquisition (MUGA)
• Trastuzumab
• Two dimensional echocardiography (2D Echo)