ArticleBreast cancer research and treatment2020
A pooled analysis of the cardiac events in the trastuzumab adjuvant trials.
Article in Breast cancer research and treatment, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 41 papers, 3 of them syntheses that pooled it.
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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.
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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.
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Who cites it
41 citing papers in PubMed, 3 syntheses or guidelines pooled it, 65 citations in OpenAlex.
- Social Determinants of Health and Cardiovascular Disease-Related Outcome Disparities Among Breast Cancer Survivors: A Systematic Review.Journal of the American Heart Association · 2026Pooled it
- Pooled it
- Six Months vs. 12 Months of Adjuvant Trastuzumab Among Women With HER2-Positive Early-Stage Breast Cancer: A Meta-Analysis of Randomized Controlled Trials.Frontiers in oncology · 2020Pooled it
- Cardiac safety of dual anti-HER2 blockade with pertuzumab plus trastuzumab in early HER2-positive breast cancer in the APHINITY trial.ESMO open · 2023Trial
- FOLFIRINOX for the Treatment of Advanced Gastroesophageal Cancers: A Phase 2 Nonrandomized Clinical Trial.JAMA oncology · 2020Trial
- Long-term cardiac outcomes of patients with HER2-positive breast cancer treated in the adjuvant lapatinib and/or trastuzumab Treatment Optimization Trial.British journal of cancer · 2020Trial
- Cardiovascular Toxicity of Novel HER2-Targeted Agents and Multikinase Inhibitors in Oncology: From Mechanisms to Real-World Clinical Evidence.Pharmaceuticals (Basel, Switzerland) · 2026Review
- Cardioprotective effects of platycodon grandiflorum granules in HER2-positive early breast cancer patients receiving trastuzumab plus pertuzumab: study protocol for a double blind randomized controlled trial.BMC complementary medicine and therapies · 2026Article
- Risk Factors for Disease Recurrence in Patients with HER2+ Early Breast Cancer and Implications for Therapy: A Narrative Review.Oncology and therapy · 2026Review
- Article
- Cardiac function surveillance practices and outcomes in patients with HER2-positive breast cancer treated with trastuzumab: a retrospective cohort study across a safety-net and tertiary care setting.Cardio-oncology (London, England) · 2025Article
- Silver Jubilee of HER2 targeting: a clinical success in breast cancer.Journal of the National Cancer Center · 2025Review
- Subtype-specific dysregulation of biogenic amine-related genes and miRNAs in breast cancer: identification of DRD2, HRH2, and HRH4 as potential therapeutic targets in TNBC and HER2+ subtypes.Breast cancer research and treatment · 2025Article
- Strategies to enhance management of HER2-positive breast cancer in the elderly: an expert consensus perspective.Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico · 2025Review
- Use of anthracyclines and trastuzumab for breast cancer in women with and without a history of cardiovascular disease in Sweden: a national cross-sectional study.Cardio-oncology (London, England) · 2025Article
- Risk Stratification for Trastuzumab-Induced Cardiac Dysfunction and Potential Implications for Surveillance.JACC. CardioOncology · 2025Article
- Incidence and risk factors of trastuzumab-induced cardiac dysfunction in a predominantly Hispanic South Texas population: a descriptive study.Cardio-oncology (London, England) · 2025Article
- Artificial Intelligence-Enhanced Risk Stratification of Cancer Therapeutics-Related Cardiac Dysfunction Using Electrocardiographic Images.Circulation. Cardiovascular quality and outcomes · 2025Article
- The Complex Connection Between Myocardial Dysfunction and Cancer Beyond Cardiotoxicity: Shared Risk Factors and Common Molecular Pathways.International journal of molecular sciences · 2024Review
- Cancer and Heart Failure: Dangerous Liaisons.Journal of cardiovascular development and disease · 2024Review
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Authors and funding
13 authors at 9 institutions in 7 countries.
Funding
Abstract
backgroundTrastuzumab-associated cardiotoxicity remains an issue for patients with HER2-positive breast cancer. This pooled analysis of 3 adjuvant trials investigated the incidence, timing, impact on treatment completion, and risk factors for trastuzumab-associated cardiotoxicity.
methodsThis is an individual patient data level pooled analysis of HERA, NSBAP B-31, and NCCTG 9831 (Alliance Trials). Definitions of cardiac events were as per each individual study.
resultsA total of 7445 patients enrolled in the 3 trials were included in the analysis, of which 4017 were in the trastuzumab and 3428 in the control (observation) arms, respectively. Median follow-up exceeded 10 years (119.2-137.2 months). Nearly all patients (97.4%) in the trastuzumab arms received anthracycline-based chemotherapy. In total, 452 patients in the trastuzumab arms experienced a cardiac event (11.3%), with most being mildly symptomatic or asymptomatic left ventricular ejection fraction (LVEF) decrease (351 patients, 8.7%). Severe congestive heart failure was more common in the trastuzumab arm (2.3%) than in the control arm (0.8%). Most cardiac events occurred during trastuzumab treatment (78.1%) and cardiac events were the main cause of discontinuation across the sample (10.0%); nevertheless, a large majority of patients completed trastuzumab treatment (76.2%). Baseline risk factors that were significantly associated with the development of cardiac events were baseline LVEF < 60%, hypertension, body mass index > 25, age ≥ 60 and, non-Caucasian ethnicity.
conclusionOne year of trastuzumab increases the risk of cardiac events, though most consist of asymptomatic or mildly symptomatic LVEF drops. Adjuvant trastuzumab should be considered a safe treatment from a cardiac standpoint for most patients. Trastuzumab-associated cardiotoxicity is the main cause of discontinuation and further research is needed to individualize prevention and management.
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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.