Journal of Clinical Oncology, Vol 20, Issue 5
(March), 2002: 1215-1221
© 2002 American Society for Clinical Oncology
Cardiac Dysfunction in the Trastuzumab Clinical Trials Experience
By Andrew Seidman,
Clifford Hudis,
Mary Kathryn Pierri,
Steven Shak,
Virginia Paton,
Mark Ashby,
Maureen Murphy,
Stanford J. Stewart,
Deborah Keefe
From the Memorial Sloan-Kettering Cancer Center, New York, NY; and Genentech Inc, South San Francisco, CA.
Address reprint requests to Andrew Seidman, MD, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021; email: seidmana{at}mskcc.org
PURPOSE: This study sought to estimate cardiac dysfunction (CD) risk for patients receiving trastuzumab; to characterize observed CD by severity, treatment, and clinical outcome; to assess effects of baseline clinical risk factors on CD; and to assess effects of cumulative doses of anthracyclines and trastuzumab on CD.
PATIENTS AND METHODS: A retrospective review of records for patients enrolled onto any of seven phase II and III trastuzumab clinical trials was performed. Predefined criteria were used for the diagnosis, and the New York Heart Association functional classification system was used to document CD severity. Product-limit estimates were used to summarize the cumulative anthracycline and trastuzumab doses at the time of CD onset.
RESULTS: Patients treated with trastuzumab were found to be at an increased risk for CD. The incidence was greatest in patients receiving concomitant trastuzumab and anthracycline plus cyclophosphamide (27%). The risk was substantially lower in patients receiving paclitaxel and trastuzumab (13%) or trastuzumab alone (3% to 7%); however, most of these patients had received prior anthracycline therapy. CD was noted in 8% of patients receiving anthracycline plus cyclophosphamide and 1% receiving paclitaxel alone. Most trastuzumab-treated patients developing CD were symptomatic (75%), and most improved with standard treatment for congestive heart failure (79%).
CONCLUSION: Trastuzumab is associated with an increased risk of CD, which is greatest in patients receiving concurrent anthracyclines. In most patients with metastatic breast cancer, the risk of CD can be justified given the improvement in overall survival previously reported with trastuzumab.

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A. P Levene, G. Singh, and C. Palmieri
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J. Baselga, X. Carbonell, N.-J. Castaneda-Soto, M. Clemens, M. Green, V. Harvey, S. Morales, C. Barton, and P. Ghahramani
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L. Del Mastro, F. Perrone, L. Repetto, L. Manzione, V. Zagonel, L. Fratino, D. Marenco, M. Venturini, E. Maggi, C. Bighin, et al.
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V. Bozionellou, D. Mavroudis, M. Perraki, S. Papadopoulos, S. Apostolaki, E. Stathopoulos, A. Stathopoulou, E. Lianidou, and V. Georgoulias
Trastuzumab Administration Can Effectively Target Chemotherapy-Resistant Cytokeratin-19 Messenger RNA-Positive Tumor Cells in the Peripheral Blood and Bone Marrow of Patients With Breast Cancer
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Y. Nieto, J. J. Vredenburgh, E. J. Shpall, S. I. Bearman, P. A. McSweeney, N. Chao, D. Rizzieri, C. Gasparetto, S. Matthes, A. E. Baron, et al.
Phase II Feasibility and Pharmacokinetic Study of Concurrent Administration of Trastuzumab and High-Dose Chemotherapy in Advanced HER2+ Breast Cancer
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[Abstract]
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E. A. Perez, V. J. Suman, N. E. Davidson, P. A. Kaufman, S. Martino, S. R. Dakhil, J. N. Ingle, R. J. Rodeheffer, B. J. Gersh, and A. S. Jaffe
Effect of Doxorubicin Plus Cyclophosphamide on Left Ventricular Ejection Fraction in Patients With Breast Cancer in the North Central Cancer Treatment Group N9831 Intergroup Adjuvant Trial
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September 15, 2004;
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[Abstract]
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A. B. Riemer, M. Klinger, S. Wagner, A. Bernhaus, L. Mazzucchelli, H. Pehamberger, O. Scheiner, C. C. Zielinski, and E. Jensen-Jarolim
Generation of Peptide Mimics of the Epitope Recognized by Trastuzumab on the Oncogenic Protein Her-2/neu
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[Abstract]
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E. T.H. Yeh, A. T. Tong, D. J. Lenihan, S. W. Yusuf, J. Swafford, C. Champion, J.-B. Durand, H. Gibbs, A. A. Zafarmand, and M. S. Ewer
Cardiovascular Complications of Cancer Therapy: Diagnosis, Pathogenesis, and Management
Circulation,
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[Abstract]
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G. Minotti, P. Menna, E. Salvatorelli, G. Cairo, and L. Gianni
Anthracyclines: Molecular Advances and Pharmacologic Developments in Antitumor Activity and Cardiotoxicity
Pharmacol. Rev.,
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[Abstract]
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J. E. Karp, I. Gojo, R. Pili, C. D. Gocke, J. Greer, C. Guo, D. Qian, L. Morris, M. Tidwell, H. Chen, et al.
Targeting Vascular Endothelial Growth Factor for Relapsed and Refractory Adult Acute Myelogenous Leukemias: Therapy with Sequential 1-{beta}-D-Arabinofuranosylcytosine, Mitoxantrone, and Bevacizumab
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[Abstract]
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M. D. Pegram, G. E. Konecny, C. O'Callaghan, M. Beryt, R. Pietras, and D. J. Slamon
Rational Combinations of Trastuzumab With Chemotherapeutic Drugs Used in the Treatment of Breast Cancer
J Natl Cancer Inst,
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[Abstract]
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M. D. Pegram, T. Pienkowski, D. W. Northfelt, W. Eiermann, R. Patel, P. Fumoleau, E. Quan, J. Crown, D. Toppmeyer, M. Smylie, et al.
Results of Two Open-Label, Multicenter Phase II Studies of Docetaxel, Platinum Salts, and Trastuzumab in HER2-Positive Advanced Breast Cancer
J Natl Cancer Inst,
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[Abstract]
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H. Burris III, D. Yardley, S. Jones, G. Houston, C. Broome, D. Thompson, F. A. Greco, M. White, and J. Hainsworth
Phase II Trial of Trastuzumab Followed by Weekly Paclitaxel/Carboplatin As First-Line Treatment for Patients With Metastatic Breast Cancer
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May 1, 2004;
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[Abstract]
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S. FOGLI, P. NIERI, and M. C. BRESCHI
The role of nitric oxide in anthracycline toxicity and prospects for pharmacologic prevention of cardiac damage
FASEB J,
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[Abstract]
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D. Tripathy, D. J. Slamon, M. Cobleigh, A. Arnold, M. Saleh, J. E. Mortimer, M. Murphy, and S. J. Stewart
Safety of Treatment of Metastatic Breast Cancer With Trastuzumab Beyond Disease Progression
J. Clin. Oncol.,
March 15, 2004;
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[Abstract]
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K. Lemmens, P. Fransen, S. U. Sys, D. L. Brutsaert, and G. W. De Keulenaer
Neuregulin-1 Induces a Negative Inotropic Effect in Cardiac Muscle: Role of Nitric Oxide Synthase
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[Abstract]
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E. A. Perez and R. Rodeheffer
Clinical Cardiac Tolerability of Trastuzumab
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January 15, 2004;
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[Abstract]
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U. Gatzemeier, G. Groth, C. Butts, N. Van Zandwijk, F. Shepherd, A. Ardizzoni, C. Barton, P. Ghahramani, and V. Hirsh
Randomized phase II trial of gemcitabine-cisplatin with or without trastuzumab in HER2-positive non-small-cell lung cancer
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[Abstract]
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A. Jones
Combining trastuzumab (Herceptin(R)) with hormonal therapy in breast cancer: what can be expected and why?
Ann. Onc.,
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[Abstract]
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G. Bianchi, J. Albanell, W. Eiermann, G. Vitali, D. Borquez, L. Vigano, R. Molina, G. Raab, A. Locatelli, B. Vanhauwere, et al.
Pilot Trial of Trastuzumab Starting with or after the Doxorubicin Component of a Doxorubicin plus Paclitaxel Regimen for Women with HER2-Positive Advanced Breast Cancer
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[Abstract]
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M. Cobleigh and D. Frame
Is Trastuzumab Every Three Weeks Ready for Prime Time?
J. Clin. Oncol.,
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B. Leyland-Jones, K. Gelmon, J.-P. Ayoub, A. Arnold, S. Verma, R. Dias, and P. Ghahramani
Pharmacokinetics, Safety, and Efficacy of Trastuzumab Administered Every Three Weeks in Combination With Paclitaxel
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R. Nahta and F. J. Esteva
HER-2-Targeted Therapy: Lessons Learned and Future Directions
Clin. Cancer Res.,
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[Abstract]
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E. Rock and A. DeMichele
Nutritional Approaches to Late Toxicities of Adjuvant Chemotherapy in Breast Cancer Survivors
J. Nutr.,
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H. J. Burstein, L. N. Harris, P. K. Marcom, R. Lambert-Falls, K. Havlin, B. Overmoyer, R. J. Friedlander Jr., J. Gargiulo, R. Strenger, C. L. Vogel, et al.
Trastuzumab and Vinorelbine as First-Line Therapy for HER2-Overexpressing Metastatic Breast Cancer: Multicenter Phase II Trial With Clinical Outcomes, Analysis of Serum Tumor Markers as Predictive Factors, and Cardiac Surveillance Algorithm
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H. Kattlove and R. J. Winn
Ongoing Care of Patients After Primary Treatment for Their Cancer
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J. Geneve
Re: Demand Grows for Early Access to Promising Cancer Drugs
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H. J. Burstein, L. N. Harris, R. Gelman, S. C. Lester, R. A. Nunes, C. M. Kaelin, L. M. Parker, L. W. Ellisen, I. Kuter, M. A. Gadd, et al.
Preoperative Therapy With Trastuzumab and Paclitaxel Followed by Sequential Adjuvant Doxorubicin/Cyclophosphamide for HER2 Overexpressing Stage II or III Breast Cancer: A Pilot Study
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[Abstract]
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E. Page, D. Assouline, O. Brun, D. Coeffic, D. Fric, P. Winckel, A. D. Seidman, M. K. Pierri, and C. Hudis
Cardiac Dysfunction in Clinical Trials of Trastuzumab
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J. Baselga
Why the Epidermal Growth Factor Receptor? The Rationale for Cancer Therapy
Oncologist,
August 15, 2002;
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[Abstract]
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J. Speyer
Cardiac Dysfunction in the Trastuzumab Clinical Experience
J. Clin. Oncol.,
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