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Role of serial cardiac monitoring with equilibrium radionuclide angiography for trastuzumab induced cardiotoxicity

¹ Nuclear Medicine, Hussain Maki al Juma Centre for Specialized Surgery, Kuwait, Kuwait

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Objectives: Trastuzumab is a monoclonal antibody used for the treatment of metastatic breast carcinoma in women whose tumors overexpress the HER2 protein. Cardiotoxicity has been reported with trastuzumab when administered alone or in combination with anthracyclines. Aim of study was serial cardiac monitoring by equilibrium radionuclide angiocardiography (ERNA) to identify patients at risk of developing unpredictable and sometimes-irreversible cardiac dysfunction on trastuzmab treatement.

Methods: 57 patients had a HER2 3+overexpressing primary tumor (immunohistochemistry) treated sequentially with trastuzumab (mean age was 48.6 yrs), with 8mg/kg loading dose and 6mg/kg maintenance dose given at 3 weekly intervals over 1 year. All patients had a baseline LVEF>50%. Standard ERNA was carried out at baseline and then at three monthly intervals (i.e. 3, 6, 9 and 12 months), and after 4 weeks after withholding Trastuzumab.

Results: The incidence of cardiotoxicity was 21% (n=12), mostly manifest as a decline in LVEF >10% from baseline, eight of these had received prior anthracycline and cyclophosphamide. Trastuzumab was discontinued for symptomatic CHF (n=2). 9 patients who improved (EF=>50%) on removal of the trastuzumab were retreated. Mean time to recovery of LVEF was 1.5 months. Inadequate recovery was seen in 3 patients.

Conclusions: Serial ERNA picked up early evidence of cardiac dysfunction that necessitated withdrawal of trastuzumab. Further ERNA studies separated patients who could be retreated from those with irreversible cardiac damage. Therefore we recommend that serial assessment of LVEF at rest by ERNA proved an effective method of monitoring patients during the course of trastuzumab.

Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Usmani, S. Articles by Javed, A. PubMed Articles by Usmani, S. Articles by Javed, A.