ArticleJournal of the National Cancer Institute2020
Impact of Stopping Trastuzumab in Early Breast Cancer: A Population-Based Study in Ontario, Canada.
Article in Journal of the National Cancer Institute, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers.
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Who cites it
28 citing papers in PubMed, 31 citations in OpenAlex.
- A Randomized Trial Comparing 3- versus 4-Monthly Cardiac Monitoring in Patients Receiving Trastuzumab-Based Chemotherapy for Early Breast Cancer.Current oncology (Toronto, Ont.) · 2021Trial
- Completion vs. early discontinuation of chemotherapy and the impact on 5-year all-cause mortality in women treated for early-stage breast cancer from 2015 to 2020: A cohort study using a target trial emulation approach.British journal of clinical pharmacology · 2026Article
- Article
- Impact of Pre-Existing Frailty on Cardiotoxicity Among Breast Cancer Patients Receiving Adjuvant Therapy.JACC. CardioOncology · 2025Article
- Cardiovascular Considerations During Cancer Therapy: Gaps in Evidence andJACC. CardioOncology · 2024Review
- Safety of Continuing Trastuzumab for Mild Cardiotoxicity: A Cardiovascular Magnetic Resonance Imaging Study.CJC open · 2024Article
- From 60% to 5% in 12 Weeks: A Trastuzumab-Induced Left Ventricular Ejection Fraction Drop.Cureus · 2024Article
- Trastuzumab in patients with breast cancer and pre-existing left ventricular systolic dysfunction.Cardio-oncology (London, England) · 2024Article
- Nomogram for Predicting Risk of Cancer Therapy-Related Cardiac Dysfunction in Patients With Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer.Journal of the American Heart Association · 2023Article
- Global Cardio Oncology Registry (G-COR): Registry Design, Primary Objectives, and Future Perspectives of a Multicenter Global Initiative.Circulation. Cardiovascular quality and outcomes · 2023Review
- Monocyte-to-lymphocyte ratio as predictor of cancer therapy-related cardiotoxicity in patients with breast cancer: a pilot cohort study.Breast cancer research and treatment · 2023Article
- Real world evidence of adjuvant trastuzumab in HER2 positive early breast cancer.Scientific reports · 2023Article
- Global longitudinal strain in cardio-oncology: worth our trouble or more trouble than it's worth?Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation · 2023Article
- Cardio-oncology in Austria: cardiotoxicity and surveillance of anti-cancer therapies : Position paper of the Heart Failure Working Group of the Austrian Society of Cardiology.Wiener klinische Wochenschrift · 2022Article
- Cardiotoxicity of adjuvant chemotherapy with trastuzumab: a Japanese claim-based data analysis.Open heart · 2022Article
- Cardioprotection for Anti-HER2 Therapy: Considerations for Primary Prevention and Use in Mildly Reduced Left Ventricular Ejection Fraction.Current oncology reports · 2022Review
- Cardioprotection of High-Risk Individuals.Heart failure clinics · 2022Review
- Cardiovascular toxicities of chemotherapies: challenging the paradigm for left ventricular ejection fraction monitoring during and after treatment.American heart journal plus : cardiology research and practice · 2022Article
- Evaluation of Risk Prediction Models to Identify Cancer Therapeutics Related Cardiac Dysfunction in Women with HER2+ Breast Cancer.Journal of clinical medicine · 2022Article
- Defining cardiovascular toxicities of cancer therapies: an International Cardio-Oncology Society (IC-OS) consensus statement.European heart journal · 2022Article
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Authors and funding
8 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAdjuvant trastuzumab for early-stage (I-III) HER2-positive breast cancer (BC) has led to statistically significant improvement in cancer outcomes but carries a risk of cardiotoxicity. Trastuzumab is discontinued early in many patients for asymptomatic changes in left ventricular ejection fraction. We evaluated the impact of early discontinuation of trastuzumab on cancer outcomes.
methodsWe conducted a retrospective population-based cohort study of early BC patients treated with adjuvant trastuzumab in Ontario, Canada, 2007-2016. Four groups were analyzed: group A was full treatment, 17-18 cycles trastuzumab; group B was cardiac event (CE) within treatment period; group C was ≤16 cycles, no CEs, stopped within 30 days from last cardiac imaging; and group D was ≤16 cycles, no CEs, stopped more than 30 days from cardiac imaging. Primary outcome was disease-free survival (DFS); secondary outcomes were: overall survival, cancer-specific mortality, and cardiovascular mortality. Sensitivity analyses were performed 14 months after cycle 1 trastuzumab to control for early relapse.
resultsA total of 5547 patients met the inclusion criteria: group A = 3921, group B = 309, group C = 362, and group D = 955. The 5-year DFS was 94.1% in group A, 80.1% in group B, 81.4% in group C, and 82.4% in group D. Using a Cox model, the hazard ratio for 5-year DFS was 3.15 (95% confidence interval [CI] = 2.13 to 4.65) for group B, 1.94 (95% CI = 1.30 to 2.89) for group C, and 1.92 (95% CI = 1.46 to 2.53) for group D. Overall, 26 patients (0.5%) died of cardiac causes.
conclusionsBC patients in Ontario who did not complete adjuvant trastuzumab had a statistically significantly higher risk of BC relapse and death and low incidence of cardiac death. These findings support 1 year of adjuvant trastuzumab in early-stage BC.
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