Credit: Original article published here.
Citing evidence that trastuzumab increased cardiac events in patients with breast cancer, researchers evaluated the cardiac safety profile of combined trastuzumab plus pertuzumab, the current standard of care for high-risk human epidermal growth factor receptor 2 (HER2)-positive early breast cancer. The data were published in ESMO Open.
According to the study’s authors, dual blockade therapy with trastuzumab plus pertuzumab did not increase the risk for cardiac events compared with trastuzumab alone. Notably, patients who received anthracycline-based chemotherapy had increased risks for cardiac events, leading authors to suggest consideration of non-anthracycline chemotherapy in patients with breast cancer.
Pertuzumab Plus Trastuzumab in HER2-Positive Breast Cancer
Researchers based their investigation on data from the phase III APHINITY trial. The trial enrolled 4769 patients with HER2-positive breast cancer with left ventricular ejection fraction (LVEF) ≥55% at baseline. LVEF was assessed every 3 months during treatment, every 6 months up to month 36, and yearly up to 10 years.
The primary end point was cardiac events consisting of heart failure class III/IV and decrease in LVEF of ≥10% from baseline to <50%. Secondary cardiac events included a significant decrease in LVEF or cardiac events, as confirmed by the cardiac advisory board.
Over a median follow-up of 74 months, cardiac events occured in 159 (3.3%) patients, 83 3.5%) in the trastuzumab plus pertuzumab group and 76 (3.2%) in the trastuzumab group. Researchers noted most events occurred during anti-HER2 treatment (n=123; 77.4%), and were mostly decreased LVEF events (n=133; 83.6%) with mild or no symptoms.
Authors identified risk factors for cardiac events including: age >65 years, body mass index ≥25 kg/m2, baseline LVEF between 55% and <60%, and anthracycline-based chemotherapy regime. Both treatment groups had 2 cardiac-related deaths (0.1%). Using recorded LVEF values, authors estimated that 127 of 155 patients had acute recovery from their cardiac events.
“The results of our study highlight the long-term cardiac safety of dual HER2-targeted therapy in this patient population,” the authors summarized. “Cardiac safety will remain an important component of patient care and research, especially as novel HER2-directed therapies emerge.”
Related: HER2-Positive Breast Cancer: 10-Year Paclitaxel and Trastuzumab Survival
