SynthesisInternal and emergency medicine2016
Risk of severe cardiotoxicity following treatment with trastuzumab: a meta-analysis of randomized and cohort studies of 29,000 women with breast cancer.
Synthesis in Internal and emergency medicine, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 48 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
48 citing papers in PubMed, 2 syntheses or guidelines pooled it, 93 citations in OpenAlex.
- Pooled it
- Grading Evaluation of Cardiotoxicity in Patients with Breast Cancer Treated with Adjuvant Paclitaxel Anthracycline/Cyclophosphamide Chemotherapy: A Meta-Analysis.Computational and mathematical methods in medicine · 2022Pooled it
- Six versus 12 months' adjuvant trastuzumab in patients with HER2-positive early breast cancer: the PERSEPHONE non-inferiority RCT.Health technology assessment (Winchester, England) · 2020Trial
- Trastuzumab-associated cardiac events in the Persephone trial.British journal of cancer · 2016Trial
- Mechanistic attenuation by L-carnitine of trastuzumab-induced downregulation of adenosine monophosphate -activated protein kinase signal in cardiac H9c2 cells.BMC pharmacology & toxicology · 2026Article
- Very Late-Onset Cancer Therapy-Related Cardiac Dysfunction After More Than 100 Courses of Anti-HER2-Based Therapy for Breast Cancer.CJC open · 2026Article
- Cardiotoxicity of monoclonal antibody-based therapies in breast cancer: a contemporary narrative review.Cardio-oncology (London, England) · 2026Review
- Investigation of potential sex-based differences in trastuzumab-induced chronic cardiotoxicity in a rat model.Frontiers in pharmacology · 2026Article
- Cardioprotective effectiveness of SGLT2 inhibitors in older diabetic women with early-stage breast cancer following anthracycline- and/or trastuzumab-based treatment.Therapeutic advances in medical oncology · 2025Article
- Article
- Predictors of trastuzumab-induced cardiotoxicity among racially and ethnically diverse patients with HER2-positive breast cancer.Cardio-oncology (London, England) · 2024Article
- De-escalation of neoadjuvant taxane and carboplatin therapy in HER2-positive breast cancer with dual HER2 blockade: a multicenter real-world experience in China.World journal of surgical oncology · 2024Article
- Takotsubo Syndrome during Pertuzumab and Trastuzumab Therapy for HER2-Positive Metastatic Breast Cancer.Biomedicines · 2024Article
- GDF-15 is a potential candidate biomarker for an elevated risk of cardiotoxicity in breast cancer patients receiving neoadjuvant dual anti-HER2 therapy.Frontiers in pharmacology · 2024Article
- Review of the clinical status of cardiotoxicity of HER-2 positive breast cancer targeted therapeutic drugs.Frontiers in oncology · 2024Review
- Cardiotoxicities of Non-Chemotherapeutic Metastatic Breast Cancer Treatments.Current oncology reports · 2023Review
- Comparison of cardiovascular disease risk in women with and without breast cancer: secondary data analysis with the 2014-2018 korean national health and nutrition examination survey.BMC public health · 2023Article
- Risk Prediction Models for Myocardial Dysfunction and Heart Failure in Patients with Current or Prior Cancer.Current oncology reports · 2023Review
- Cardiotoxicity among socioeconomically marginalized breast cancer patients.Breast cancer research and treatment · 2022Article
- Cardiovascular Imaging in Cardio-Oncology: The Role of Echocardiography and Cardiac MRI in Modern Cardio-Oncology.Heart failure clinics · 2022Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 5 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Trastuzumab prolongs survival in women with HER2-positive breast cancer, but may increase the risk of heart disease. The occurrence of severe cardiotoxicity, however, is not defined in real-life settings. We performed a meta-analysis of clinical trials and cohort studies to estimate the frequency of cardiotoxicities following trastuzumab treatment. We searched MEDLINE, EMBASE, and the Cochrane Library (1996-January 2014). The primary outcome was the frequency of severe cardiotoxicities up to 3-years after trastuzumab initiation. Among 58 studies (29,598 patients), severe cardiotoxicity occurred in 3.00% (95% CI 2.41-3.64), 2.62% (95% CI 1.97-3.35), and 3.14% (95% CI 2.12-4.37) of overall, early (EBC) and metastatic (MBC) breast cancer patients, respectively. In EBC, the proportion increased from 2.40% at the first year to a plateau of approximately 3% after the second year. In MBC, the proportion increased from 3.00 to 3.68% when trastuzumab was used as first line or further lines of therapy, respectively. In EBC, cardiotoxicity occurred in 2.90% of patients treated with taxanes and anthracyclines compared to 0.92% in patients treated with taxanes without anthracyclines. The occurrence of cardiotoxicity varied according to age, increasing from 2.31% in individuals <50 years, to 3.46% in those 50-59 years, to 4.91% in those >60 years of age. Cardiotoxicity was higher in smokers (5.3%), dyslipidemic patients (3.9%), BMI ≥25 (6.5%), diabetes (6.2%), hypertension (5.5%), or positive history of cardiac disease (19.1%). RCTs consistently report lower cardiac toxicity rates than observational studies (EBC: 1.7 versus 3.2; MBC: 2.8 versus 4.4). Following trastuzumab initiation, approximately three in 100 patients develop severe cardiotoxicity after 2 years. Patients enrolled in cohort studies, who more closely reflect women treated for breast cancer in real-life settings compared to RCTs, are at higher risk of developing cardiac events.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.