Background: Current guidelines recommend monitoring cardiac function every 3 months in patients on anti-HER2 therapies, such as trastuzumab and pertuzumab. The purpose of this study is to assess the frequency of ECHO monitoring in the real-world setting and to identify the incidence of anti-HER2 therapy related cardiac events within 1 year of treatment in patients with breast cancer. Methods: Patients initiated on anti-HER2 therapies from December 2018 to December 2019 for Stage I-IV HER2 positive breast cancer were included in this single center, retrospective chart review. Patients were followed for 1 year. The total number of patients who had at least 1 dose held or who had treatment discontinued for the development of a cardiac event (drop in ejection fraction [EF], arrhythmia, myocardial infarction [MI], death or other [structural changes on ECHO]) was assessed. Baseline cardiovascular risk factors were collected along with frequency of ECHO monitoring. Results: Of the 153 patients, 16 (10%) had a dose held for the development of a cardiac event. At baseline, 4 (25%) had a history of prior anthracycline, none had a baseline ECHO of less than 55% and 9 (56%) had 2 or more cardiac risk factors. A cardiac event occurred within 3 months of treatment initiation in 7 (43.8%) of the patients with doses held, with 5 (71.4%) of these patients having a history of prior anthracycline or 2 or more baseline cardiac risk factors. Of the patients who had doses held, 8 (5%) continued on treatment, while 8 (5%) had treatment discontinued. Of the patients who continued on treatment, 7 had treatment held for a drop in EF (average drop 9.7%), while 1 had treatment held for a structural change on ECHO. The average onset of a cardiac event was 26.4 weeks. Of the 8 patients who had treatment discontinued, 7 had a drop in EF (average drop 15.4%) while 1 developed an arrhythmia. Average onset of a cardiac event was 24.9 weeks. Of all 153 patients, 8 (5.2%) had no baseline cardiac risk factors or history of anthracycline but developed a cardiac event. ECHOs were monitored every 1-3 months in 55.6% of patients and every 4-6 months in 40.5% of patients. Conclusion: In patients with a history of prior anthracycline, or with at least 2 or more cardiovascular risk factors, ECHO monitoring should continue every 3 months. However, in patients with no baseline cardiovascular risk factors or history of anthracycline, extending ECHO surveillance to every 6 months may be considered.
BPI23-012: Real-World Frequency of ECHO Monitoring and Incidence of Anti-HER2 Therapy Related Cardiac Events in HER2+ Breast Cancer Patients
Authors:
,
,
,
,
, and
Annette Hood
PharmD
Annette Hood
Smilow Cancer Hospital at Yale New Haven Hospital; New Haven, CT
Search for other papers by Annette Hood in
Current site
Google Scholar
PubMed
Search for other papers by Annette Hood in
Current site
Google Scholar
PubMed
Blerina Mukallari
PharmD
Blerina Mukallari
Smilow Cancer Hospital at Yale New Haven Hospital; New Haven, CT
Search for other papers by Blerina Mukallari in
Current site
Google Scholar
PubMed
Search for other papers by Blerina Mukallari in
Current site
Google Scholar
PubMed
Jacqueline Majeski
PharmD
Jacqueline Majeski
Smilow Cancer Hospital at Yale New Haven Hospital; New Haven, CT
Search for other papers by Jacqueline Majeski in
Current site
Google Scholar
PubMed
Search for other papers by Jacqueline Majeski in
Current site
Google Scholar
PubMed
Lajos Pusztai
MD
Lajos Pusztai
Yale Cancer Center/Yale University; New Haven, CT
Search for other papers by Lajos Pusztai in
Current site
Google Scholar
PubMed
Search for other papers by Lajos Pusztai in
Current site
Google Scholar
PubMed
Kerin Adelson
MD
Kerin Adelson
Yale Cancer Center/Yale University; New Haven, CT
Search for other papers by Kerin Adelson in
Current site
Google Scholar
PubMed
Search for other papers by Kerin Adelson in
Current site
Google Scholar
PubMed
Kejal Amin
PharmD
Kejal Amin
Smilow Cancer Hospital at Yale New Haven Hospital; New Haven, CT
Search for other papers by Kejal Amin in
Current site
Google Scholar
PubMed
Search for other papers by Kejal Amin in
Current site
Google Scholar
PubMed
© 2019-2024 National Comprehensive Cancer Network