News

Trastuzumab cardiotoxicity in early-stage breast cancer

Women with breast cancer who are
treated with regimens containing
trastuzumab are at heightened risk
of cardiotoxicity, according to new
research.
The retrospective cohort study examined the records of 18 540 Canadian
women diagnosed with early-stage
breast cancer from 200712.
10 160 women were treated with
anthracycline-based chemotherapy
without trastuzumab, 832 with nonanthracycline chemo therapy and
trastuzumab, 3250 with sequential
anthracyclines followed by trastuzumab,
and 4298 with other chemotherapy.
After 3 years of follow-up, 308%
(95% CI 281336) of the cohort
had experienced either congestive
heart failure (CHF) or cardiovascular
death, compared with 096%
(95% CI 089104) in a control group of
92 700 age-matched Canadian women
without breast cancer. A treatment

regimen of non-anthracycline chemotherapy and trastuzumab led to a

much higher risk of major cardiac
events than other chemotherapies
(hazard ratio [HR] 176, 95% CI
119260), as did sequential treatment
(HR 396, 301522).
Patients who underwent sequential
treatment were almost twice
as likely as those who had other
chemotherapy to be admitted to
hospital for cardiac events (HR 186,
95% CI 107322). Anthracyclines with
no trastuzumab was not associated
with an increased risk of cardiotoxicity
compared with other chemotherapies
(HR 097, 95% CI 073127).
Moreover, although the absolute
cardiotoxicity risk increased with age,
the investigators did not nd a relation
between age and treatment and the
risk of major cardiac events. There
has been a tendency for physicians to
follow older survivors of breast cancer

more closely than younger ones,

explained lead author Paaladinesh
Thavendiranathan (University of
Toronto, Toronto, ON, Canada).
This study shows that we have to take
younger populations seriously from a
cardiovascular perspective.
Peter Johnson (University of
Southampton, Southampton, UK)
welcomed the ndings. They extend
what we know from clinical trials into
a broad population-based setting, he
said. He pointed out that doxorubicin
and trastuzumab make a significant
difference to survival rates for
early-stage breast cancer. The study
highlights once again the need for a
focus on living beyond cancerwe have
to be careful when we organise our
health-care systems to make suitable
provisions for the long-term ongoing
care of cancer survivors, he said.

Lancet Oncol 2016

Published Online
April 28, 2016
http://dx.doi.org/10.1016/
S1470-2045(16)30114-0
For the study by
Thavendiranathan and
colleagues see J Clin Oncol 2016;
published online April 18.
http://dx.doi.org/10.1200/
JCO.2015.65.1505

Talha Khan Burki

www.thelancet.com/oncology Published online April 28, 2016 http://dx.doi.org/10.1016/S1470-2045(16)30114-0