ArticleBreast cancer research and treatment2021
Cardiotoxicity during long-term trastuzumab use in patients with HER2-positive metastatic breast cancer: who needs cardiac monitoring?
Article in Breast cancer research and treatment, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 1 of them a synthesis that pooled it.
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Who cites it
19 citing papers in PubMed, 1 synthesis or guideline pooled it, 25 citations in OpenAlex.
- Safety of Permissive Cardiotoxicity of Trastuzumab in Patients with Breast Cancer: A Systematic Review and Meta-Analysis.Cardiovascular toxicology · 2025Pooled it
- Time to Personalize Surveillance for Cancer Therapy-Related Cardiac Dysfunction in HER2-Targeted Therapy: One Size Does Not Fit All.Current heart failure reports · 2026Review
- Initial chemotherapy dose reductions and subsequent treatment delivery in stage I-IIIA breast cancer.Cancer · 2026Article
- Signaling pathways and potential therapeutic agents in trastuzumab-induced cardiotoxicity.Apoptosis : an international journal on programmed cell death · 2026Review
- Addressing Cardiotoxicity Risks in Long-term Use of Human Epidermal Growth Factor Receptor 2 Inhibitors.Internal medicine (Tokyo, Japan) · 2025Article
- Delayed Trastuzumab-induced Cardiotoxicity Leading to Severe Left Ventricular Dysfunction.Internal medicine (Tokyo, Japan) · 2025Article
- Optimal follow-up duration of cardiac function tests in patients treated with trastuzumab: an analysis using the Japanese Adverse Drug Event Report (JADER) database.International journal of clinical oncology · 2025Article
- Exogenous SPD inhibits trastuzumab-mediated cardiomyocyte pyroptosis through SIRT3-regulated mitochondrial quality control.International journal of biological sciences · 2025Article
- Delayed Cardiac Dysfunction During Prolonged Use of Trastuzumab for the Treatment of HER2-Positive Metastatic Breast Cancer.Breast cancer (Dove Medical Press) · 2025Article
- Adeno-associated virus-mediated trastuzumab delivery to the central nervous system for human epidermal growth factor receptor 2+ brain metastasis.Cancer gene therapy · 2024Article
- Real-world impact of dual anti-HER2 antibodies on cardiac function in patients with human epidermal growth factor receptor 2-positive metastatic breast cancer.Breast (Edinburgh, Scotland) · 2024Article
- Reduced Tumor Volume and Increased Necrosis of Human Breast Tumor Xenograft in Mice Pretreated by a Cocktail of Three Specific Anti-HER2 scFvs.Current protein & peptide science · 2024Article
- Cardiotoxicity among socioeconomically marginalized breast cancer patients.Breast cancer research and treatment · 2022Article
- The effect of trastuzumab on cardiac function in patients with HER2-positive metastatic breast cancer and reduced baseline left ventricular ejection fraction.International journal of cancer · 2022Article
- Is there a window of opportunity to optimize trastuzumab cardiac monitoring?World journal of cardiology · 2022Article
- Cardiac Function after Modern Radiation Therapy with Volumetric Modulated Arc Therapy or Helical Tomotherapy for Advanced Left-Breast Cancer Receiving Regional Nodal Irradiation.Bioengineering (Basel, Switzerland) · 2022Article
- Cardiac Monitoring and Heart Failure in Advanced Breast Cancer Patients Treated With Trastuzumab in Ontario, Canada.Frontiers in cardiovascular medicine · 2022Article
- 2D-echocardiography vs cardiac MRI strain: a prospective cohort study in patients with HER2-positive breast cancer undergoing trastuzumab.Cardiovascular ultrasound · 2021Article
- Irreversible cardiotoxicity induced by trastuzumab: a systematic review based on a pharmacovigilance case report.Archivos peruanos de cardiologia y cirugia cardiovascularArticle
Corrections and comments
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Authors and funding
16 authors at 9 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposePatients with HER2-positive metastatic breast cancer (MBC) usually receive many years of trastuzumab treatment. It is unknown whether these patients require continuous left ventricular ejection fraction (LVEF) monitoring. We studied a real-world cohort to identify risk factors for cardiotoxicity to select patients in whom LVEF monitoring could be omitted.
methodsWe included patients with HER2-positive MBC who received > 1 cycle of trastuzumab-based therapy in eight Dutch hospitals between 2000 and 2014. Cardiotoxicity was defined as LVEF < 50% that declined > 10%-points and was categorized into non-severe cardiotoxicity (LVEF 40-50%) and severe cardiotoxicity (LVEF < 40%). Multivariable Cox and mixed model analyses were performed to identify risk factors associated with cardiotoxicity. Additionally, we explored the reversibility of cardiotoxicity in patients who continued trastuzumab.
resultsIn total, 429 patients were included. Median follow-up for cardiotoxicity was 15 months (interquartile range 8-31 months). The yearly incidence of non-severe + severe cardiotoxicity in the first and second year was 11.7% and 9.1%, respectively, which decreased thereafter. The yearly incidence of severe cardiotoxicity was low (2.8%) and stable over time. In non-smoking patients with baseline LVEF > 60% and no cardiotoxicity during prior neoadjuvant/adjuvant treatment, the cumulative incidence of severe cardiotoxicity was 3.1% after 4 years of trastuzumab. Despite continuing trastuzumab, LVEF decline was reversible in 56% of patients with non-severe cardiotoxicity and in 33% with severe cardiotoxicity.
conclusionsSerial cardiac monitoring can be safely omitted in non-smoking patients with baseline LVEF > 60% and without cardiotoxicity during prior neoadjuvant/adjuvant treatment.
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