A multicenter retrospective study of early cardiac toxicity in operable breast cancer patients receiving concurrent dual or mono anti-HER2 therapy with postoperative radiation therapy
Purpose: This study aims to assess whether dual anti-HER2 therapy with trastuzumab and pertuzumab increases early cardiac toxicity compared to trastuzumab alone in breast cancer (BC) patients receiving postoperative radiation therapy (RT). Methods: Consecutive operable BC patients receiving postoper...
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Elsevier
2025-02-01
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| Series: | Breast |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S0960977625000086 |
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| author | Jing Yang Meng-Yun Zhou Bo Yu Qing Lin Yuan Yao Hua-Ling Wu Qi-Wei Zhu Ming Ye Hua-Ying Xie Jian-Wei Wu Gang Cai Rong Cai Wei-Xiang Qi Jia-Yi Chen Lu Cao |
| author_facet | Jing Yang Meng-Yun Zhou Bo Yu Qing Lin Yuan Yao Hua-Ling Wu Qi-Wei Zhu Ming Ye Hua-Ying Xie Jian-Wei Wu Gang Cai Rong Cai Wei-Xiang Qi Jia-Yi Chen Lu Cao |
| author_sort | Jing Yang |
| collection | DOAJ |
| description | Purpose: This study aims to assess whether dual anti-HER2 therapy with trastuzumab and pertuzumab increases early cardiac toxicity compared to trastuzumab alone in breast cancer (BC) patients receiving postoperative radiation therapy (RT). Methods: Consecutive operable BC patients receiving postoperative RT and trastuzumab with or without pertuzumab between January 2017 and September 2020 at seven tertiary hospitals in China were retrospectively reviewed. Cardiac examinations included echocardiography, electrocardiogram (ECG), NT-proBNP, and cTnI at baseline before RT and during the follow-up. The cardiac event is any new-onset symptomatic heart disease or abnormality in the cardiac examination after RT. Results: In total, 681 patients were enrolled in the analysis, of whom 567 were treated with trastuzumab-alone and 124 patients received dual anti-HER2 therapy. The median follow-up was 11 months. Multivariate analysis showed that left-sided breast cancer (HR 2.38; 95%CI 1.65–3.44, p < 0.001) and IMN RT (HR 1.47; 95 % CI 1.01–2.15, P-value = 0.047) are independent risk factors for ECG abnormalities. Age >50 years is an independent risk factor for developing LVDD (HR 5.16; 95%CI 1.17–22.73, P-value = 0.030). Dosimetric analysis showed that patients who developed subclinical cardiac events had increased mean heart dose (412.0 ± 249.6 vs. 347.2 ± 242.6 cGy, P-value = 0.010). Among right-sided patients or patients receiving anthracycline-based chemotherapy, the dual-targeted cohort had a higher risk of developing ECG abnormalities compared to the trastuzumab-only cohort. Conclusion: Compared with trastuzumab-only, dual anti-HER2 therapy does not increase early cardiac toxicity in combination with postoperative RT in BC patients. Cardiac radiation exposure remains the primary risk factor for early toxicity. |
| format | Article |
| id | doaj-art-77d36bda7ff7403a9e8cb7d2b9f826e8 |
| institution | Kabale University |
| issn | 1532-3080 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Breast |
| spelling | doaj-art-77d36bda7ff7403a9e8cb7d2b9f826e82025-02-12T05:30:40ZengElsevierBreast1532-30802025-02-0179103879A multicenter retrospective study of early cardiac toxicity in operable breast cancer patients receiving concurrent dual or mono anti-HER2 therapy with postoperative radiation therapyJing Yang0Meng-Yun Zhou1Bo Yu2Qing Lin3Yuan Yao4Hua-Ling Wu5Qi-Wei Zhu6Ming Ye7Hua-Ying Xie8Jian-Wei Wu9Gang Cai10Rong Cai11Wei-Xiang Qi12Jia-Yi Chen13Lu Cao14Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China; Shanghai Key Laboratory of Proton Therapy, Shanghai, 201801, ChinaDepartment of Radiotherapy, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, ChinaDepartment of Radiotherapy, The Affiliated Jiangyin Hospital of Nantong University, Jiangyin, ChinaDepartment of Radiation Oncology, Shanghai Tenth People's Hospital, Shanghai, ChinaDepartment of Radiotherapy, Shanghai Ninth People's Hospital, Shanghai, ChinaDepartment of Radiation Oncology, Shanghai Tenth People's Hospital, Shanghai, ChinaDepartment of Radiation Oncology, Affiliated Tumor Hospital of Nantong University, Nantong, ChinaDepartment of Radiation Oncology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, ChinaDepartment of Radiation Oncology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, ChinaDepartment of Radiotherapy, Shanghai Ninth People's Hospital, Shanghai, ChinaDepartment of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China; Shanghai Key Laboratory of Proton Therapy, Shanghai, 201801, ChinaDepartment of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China; Shanghai Key Laboratory of Proton Therapy, Shanghai, 201801, ChinaDepartment of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China; Shanghai Key Laboratory of Proton Therapy, Shanghai, 201801, ChinaDepartment of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China; Shanghai Key Laboratory of Proton Therapy, Shanghai, 201801, China; Corresponding author. Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Second Road, Shanghai, 200025, China.Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China; Shanghai Key Laboratory of Proton Therapy, Shanghai, 201801, China; Corresponding author. Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Second Road, Shanghai, 200025, China.Purpose: This study aims to assess whether dual anti-HER2 therapy with trastuzumab and pertuzumab increases early cardiac toxicity compared to trastuzumab alone in breast cancer (BC) patients receiving postoperative radiation therapy (RT). Methods: Consecutive operable BC patients receiving postoperative RT and trastuzumab with or without pertuzumab between January 2017 and September 2020 at seven tertiary hospitals in China were retrospectively reviewed. Cardiac examinations included echocardiography, electrocardiogram (ECG), NT-proBNP, and cTnI at baseline before RT and during the follow-up. The cardiac event is any new-onset symptomatic heart disease or abnormality in the cardiac examination after RT. Results: In total, 681 patients were enrolled in the analysis, of whom 567 were treated with trastuzumab-alone and 124 patients received dual anti-HER2 therapy. The median follow-up was 11 months. Multivariate analysis showed that left-sided breast cancer (HR 2.38; 95%CI 1.65–3.44, p < 0.001) and IMN RT (HR 1.47; 95 % CI 1.01–2.15, P-value = 0.047) are independent risk factors for ECG abnormalities. Age >50 years is an independent risk factor for developing LVDD (HR 5.16; 95%CI 1.17–22.73, P-value = 0.030). Dosimetric analysis showed that patients who developed subclinical cardiac events had increased mean heart dose (412.0 ± 249.6 vs. 347.2 ± 242.6 cGy, P-value = 0.010). Among right-sided patients or patients receiving anthracycline-based chemotherapy, the dual-targeted cohort had a higher risk of developing ECG abnormalities compared to the trastuzumab-only cohort. Conclusion: Compared with trastuzumab-only, dual anti-HER2 therapy does not increase early cardiac toxicity in combination with postoperative RT in BC patients. Cardiac radiation exposure remains the primary risk factor for early toxicity.http://www.sciencedirect.com/science/article/pii/S0960977625000086Breast cancerRadiation therapyDual anti-HER2 therapyCardiotoxicity |
| spellingShingle | Jing Yang Meng-Yun Zhou Bo Yu Qing Lin Yuan Yao Hua-Ling Wu Qi-Wei Zhu Ming Ye Hua-Ying Xie Jian-Wei Wu Gang Cai Rong Cai Wei-Xiang Qi Jia-Yi Chen Lu Cao A multicenter retrospective study of early cardiac toxicity in operable breast cancer patients receiving concurrent dual or mono anti-HER2 therapy with postoperative radiation therapy Breast Breast cancer Radiation therapy Dual anti-HER2 therapy Cardiotoxicity |
| title | A multicenter retrospective study of early cardiac toxicity in operable breast cancer patients receiving concurrent dual or mono anti-HER2 therapy with postoperative radiation therapy |
| title_full | A multicenter retrospective study of early cardiac toxicity in operable breast cancer patients receiving concurrent dual or mono anti-HER2 therapy with postoperative radiation therapy |
| title_fullStr | A multicenter retrospective study of early cardiac toxicity in operable breast cancer patients receiving concurrent dual or mono anti-HER2 therapy with postoperative radiation therapy |
| title_full_unstemmed | A multicenter retrospective study of early cardiac toxicity in operable breast cancer patients receiving concurrent dual or mono anti-HER2 therapy with postoperative radiation therapy |
| title_short | A multicenter retrospective study of early cardiac toxicity in operable breast cancer patients receiving concurrent dual or mono anti-HER2 therapy with postoperative radiation therapy |
| title_sort | multicenter retrospective study of early cardiac toxicity in operable breast cancer patients receiving concurrent dual or mono anti her2 therapy with postoperative radiation therapy |
| topic | Breast cancer Radiation therapy Dual anti-HER2 therapy Cardiotoxicity |
| url | http://www.sciencedirect.com/science/article/pii/S0960977625000086 |
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