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Pinho J, Carvalho M, Paiva M, Teixeira-Tavares N, Costa-Santos C, Sousa C. Is dyslipidemia a risk factor for trastuzumab-induced cardiotoxicity in breast cancer patients? A systematic review and meta-analysis. Rev Port Cardiol 2023; 42:961-984. [PMID: 37399885 DOI: 10.1016/j.repc.2022.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/11/2022] [Indexed: 07/05/2023] Open
Abstract
INTRODUCTION Breast cancer patients undergoing trastuzumab therapy have greater risk of cardiovascular disease. Risk factors for this effect have been proposed. However, the role of dyslipidemia is not completely understood. This systematic review aimed to explore the role of dyslipidemia in trastuzumab-induced cardiotoxicity. METHODS The investigators searched MEDLINE, Scopus, and Web of Science up to October 25, 2020. A random-effects model was used to determine pooled estimates of the results. The primary endpoint was trastuzumab-induced cardiotoxicity in patients with and without dyslipidemia. RESULTS A total of 39 studies were selected for inclusion in our systematic review assessing 21079 patients. One study demonstrated a statistically significant association between dyslipidemia and cardiotoxicity (OR=2.28, 95% CI 1.22-4.26, p=0.01). In all other studies, no such association was observed. Twenty-one studies including 6135 patients were eligible for meta-analysis. In this meta-analysis of unadjusted data, dyslipidemia was significantly associated with cardiotoxicity (OR=1.25, 95% CI 1.01-1.53, p=0.04, I2=0%), however, a subgroup analysis of studies reporting adjusted measures did not demonstrate a significant association (OR=0.89, 95% CI 0.73-1.10, p=0.28, I2=0%). CONCLUSION This systematic review and meta-analysis did not demonstrate a significant association between dyslipidemia alone and the development of cardiotoxicity. In the absence of other relevant cardiovascular risk factors, review of lipid profile may not be obligatory, and management of patients could be performed without referral for cardio-oncology assessment. Further investigation of risk factors for trastuzumab-induced cardiotoxicity is required to confirm these results.
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Affiliation(s)
- Jaime Pinho
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
| | - Miguel Carvalho
- Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Mariana Paiva
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Centro Hospitalar e Universitário de São João, Porto, Portugal
| | | | | | - Carla Sousa
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Centro Hospitalar e Universitário de São João, Porto, Portugal
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2
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Valente PMS, da Silva PN, da Silva LE, Martins WDA, de Castilho SR. Cardiovascular adverse effects associated with the use of anti-HER2 in breast cancer treatment. Front Pharmacol 2023; 14:1099545. [PMID: 37795021 PMCID: PMC10545840 DOI: 10.3389/fphar.2023.1099545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 08/01/2023] [Indexed: 10/06/2023] Open
Abstract
Background: Cancer represents an important public health problem with increasing incidence, prevalence, and mortality, affecting the entire Western population, especially in developed and developing countries. The use of monoclonal antibodies has revolutionized the treatment of cancer, but this treatment can cause adverse cardiovascular effects (AE). Objective: The objective of this paper is to identify and classify AE in breast cancer patients in the use of Trastuzumab in two health institutions. Methods: Retrospective study of medical records of patients with breast cancer Her 2+ submitted the therapy with trastuzumab in early and advanced stage of the disease. Review conducted in a university hospital and a private clinic, both located in Rio de Janeiro State, Brazil. Results: Cardiovascular events were late for trastuzumab, with predominance of moderate reactions. There was a predominance of dyspnea, increased blood pressure, fatigue and reduced left ventricular ejection. Conclusion: The results resemble similarities in the pattern of the institutions' reactions. Identify possible AE and know the toxicity profile of trastuzumab can contribute to a safer therapy.
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Affiliation(s)
- Patricia Marques Soares Valente
- Programa de Pós-Graduação em Ciências Aplicadas à Produtos para a Saúde, Faculdade de Farmácia, Universidade Federal Fluminense, Niterói, Brazil
| | | | | | - Wolney de Andrade Martins
- Curso de Pós-Graduação em Ciências Cardiovasculares, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, Brazil
| | - Selma Rodrigues de Castilho
- Programa de Pós-Graduação em Ciências Aplicadas à Produtos para a Saúde, Faculdade de Farmácia, Universidade Federal Fluminense, Niterói, Brazil
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3
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Silva PND, Valente PMS, Castilho SRD. Monoclonal-induced cardiotoxicity in patients with non-Hodgkin's lymphoma and breast cancer: A retrospective study in an oncology clinic. J Oncol Pharm Pract 2022:10781552221098426. [PMID: 35542978 DOI: 10.1177/10781552221098426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Monoclonal antibodies, such as trastuzumab and rituximab, significantly contribute to the oncological therapeutic arsenal. However, they may be associated with the development of cardiotoxicity. This study collected data from clinical records of patients in the use of rituximab and trastuzumab in a private oncology clinic from 2017 to 2019. It also investigated cardiovascular adverse drug reactions and associated risk factors. Cardiotoxicity was defined as symptomatic in the presence of signs and symptoms suggestive of heart failure (HF) such as dyspnea, nocturnal cough, and fatigue, among others. Asymptomatic HF was confirmed by the decline in the left ventricular ejection fraction (LVEF) ≥10% of baseline or LVEF ≤50%. Among the 57 patients undergoing trastuzumab, 12 patients (21%) had cardiotoxicity and 8 patients (67%) had extreme or high-risk scores in the cardiotoxicity risk assessment algorithm. Among the 37 patients treated with rituximab, 3 patients (8%) had cardiotoxicity. The presence of previous diabetes mellitus significantly increased the risk of trastuzumab-induced cardiotoxicity (p = 0.02). However, none of the other risk factors influenced the incidence of trastuzumab- and rituximab-induced cardiotoxicity, which the sample size may explain. More studies are needed to investigate the association of risk factors with cardiotoxicity induced by trastuzumab and rituximab, aiming to establish strategies to prevent and manage this effect early.
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Affiliation(s)
| | - Patrícia Marques Soares Valente
- 28110Universidade Federal Fluminense-UFF, Programa de Pós-graduação em Ciências Aplicadas à Produtos para a Saúde-PPG CAPS, Niteroi, Rio de Janeiro, Brazil
| | - Selma Rodrigues de Castilho
- 28110Universidade Federal Fluminense-UFF, Programa de Pós-graduação em Ciências Aplicadas à Produtos para a Saúde-PPG CAPS, Niteroi, Rio de Janeiro, Brazil
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4
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Kok CY, MacLean LM, Ho JC, Lisowski L, Kizana E. Potential Applications for Targeted Gene Therapy to Protect Against Anthracycline Cardiotoxicity: JACC: CardioOncology Primer. JACC CardioOncol 2022; 3:650-662. [PMID: 34988473 PMCID: PMC8702812 DOI: 10.1016/j.jaccao.2021.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/30/2021] [Accepted: 09/08/2021] [Indexed: 12/26/2022] Open
Abstract
Anthracyclines are associated with risk of significant dose-dependent cardiotoxicity. Conventional heart failure therapies have neither ameliorated declining cardiac function nor addressed the underlying cause. Gene therapy may confer long-term cardioprotection by rendering the heart resistant to anthracyclines after 1 treatment, although the optimal therapeutic target remains to be elucidated. Recombinant adeno-associated virus is now clinically approved for the treatment of lipoprotein lipase deficiency, spinal muscular atrophy, and hereditary transthyretin amyloidosis. High-throughput methods allow selection of recombinant adeno-associated virus capsids that facilitate efficient gene delivery to specific target cells. Vector safety is enhanced by incorporating cardiac-specific promoters into vector design and localizing delivery to reduce off-target risk. Any cardioprotective transgene may bear a degree of risk as they may play as yet unknown roles, which require careful assessment using clinically relevant models. The innovative technologies outlined here make gene therapy a promising proof of principle, with potential further application to nonanthracycline chemotherapeutics. Protection against anthracycline cardiotoxicity may be achieved by gene delivery to the heart. The optimal cardioprotective target gene remains to be identified. Targeted gene expression in human myocytes can now be achieved with advances in AAV vectorology. It is critical to minimize risk of off-target effects which may impede anthracycline oncotherapy.
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Affiliation(s)
- Cindy Y Kok
- Centre for Heart Research, The Westmead Institute for Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Westmead Clinical School, the Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Lauren M MacLean
- Centre for Heart Research, The Westmead Institute for Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jett C Ho
- Centre for Heart Research, The Westmead Institute for Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Leszek Lisowski
- Military Institute of Medicine, Laboratory of Molecular Oncology and Innovative Therapies, Warsaw, Poland.,Translational Vectorology Research Unit, Children's Medical Research Institute, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia.,Vector and Genome Engineering Facility, Children's Medical Research Institute, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
| | - Eddy Kizana
- Centre for Heart Research, The Westmead Institute for Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Westmead Clinical School, the Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
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5
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Reding KW, Ghemigian K, Carbone S, D'Agostino R, Jordan JH, Meléndez G, Lamar ZS, Klepin HD, Thomas A, Langford D, Vasu S, Hundley WG. The relationship between abdominal fat and change in left ventricular ejection fraction in cancer patients. Obes Sci Pract 2020; 7:82-90. [PMID: 33680495 PMCID: PMC7909597 DOI: 10.1002/osp4.454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 08/03/2020] [Accepted: 09/06/2020] [Indexed: 12/17/2022] Open
Abstract
Objectives Prior studies have identified a relationship between body mass index (BMI) and intraperitoneal (IP) fat with heart failure; however, in prior studies of cancer patients receiving potentially cardiotoxic chemotherapy, elevations in BMI have not necessarily been associated with decrements in heart function. This study tested the hypothesis that IP fat may be associated with left ventricular ejection fraction (LVEF) decline among cancer patients receiving potentially cardiotoxic chemotherapy. Methods In this prospective study of 61 cancer patients (23 breast cancer, 32 lymphoma, and 6 sarcoma), IP fat and other assessments of body composition, and changes in LVEF from pre- to postcancer treatment using noninvasive magnetic resonance imaging was ascertained. Results After accounting for age, baseline LVEF, and confounding variables, pre- to 24-month post-treatment LVEF changes were inversely correlated with IP fat (r = -0.33; p = 0.02) and positively correlated with measures of subcutaneous (SQ) fat (r = 0.33; p = 0.01). These LVEF changes were not correlated with BMI (r = 0.12; p = 0.37). Conclusion Among patients receiving potentially cardiotoxic chemotherapy, pretreatment IP fat was associated with subsequent declines in LVEF. There was no association between BMI and LVEF decline. These findings may be related to a potential protective effect of SQ fat.
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Affiliation(s)
- Kerryn W Reding
- Department of Biobehavioral Nursing and Health Informatics University of Washington School of Nursing Washington Seattle USA.,Division of Public Health Sciences Fred Hutchinson Cancer Research Center Washington Seattle USA
| | - Khristine Ghemigian
- Department of Internal Medicine Section on Cardiovascular Medicine Wake Forest University Winston-Salem North Carolina USA
| | - Salvatore Carbone
- Department of Internal Medicine VCU Pauley Heart Center Virginia Commonwealth University School of Medicine Richmound Virginia USA
| | - Ralph D'Agostino
- Department of Biostatistical Sciences Wake Forest University Winston-Salem North Carolina USA
| | - Jennifer H Jordan
- Department of Internal Medicine VCU Pauley Heart Center Virginia Commonwealth University School of Medicine Richmound Virginia USA.,Department of Biomedical Engineering Virginia Commonwealth University Richmound Virginia USA
| | - Giselle Meléndez
- Department of Internal Medicine Section on Cardiovascular Medicine Wake Forest University Winston-Salem North Carolina USA.,Department of Pathology Section on Comparative Medicine Wake Forest University Winston-Salem North Carolina USA
| | - Zanetta S Lamar
- Department of Internal Medicine Section on Hematology and Oncology Wake Forest University Winston-Salem North Carolina USA
| | - Heidi D Klepin
- Department of Internal Medicine Section on Hematology and Oncology Wake Forest University Winston-Salem North Carolina USA
| | - Alexandra Thomas
- Department of Internal Medicine Section on Hematology and Oncology Wake Forest University Winston-Salem North Carolina USA
| | - Dale Langford
- Department of Anesthesiology and Pain Medicine University of Washington School of Medicine Washington Seattle USA
| | - Sujethra Vasu
- Department of Internal Medicine Section on Cardiovascular Medicine Wake Forest University Winston-Salem North Carolina USA
| | - W Gregory Hundley
- Department of Internal Medicine Section on Cardiovascular Medicine Wake Forest University Winston-Salem North Carolina USA.,Department of Internal Medicine VCU Pauley Heart Center Virginia Commonwealth University School of Medicine Richmound Virginia USA
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6
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Alghafar DA, Younos I, Baimani KA, Al-Salhi D, Al-Riyami A, Rizvi S, Buckley NE. Trastuzumab cardiotoxicity in HER2-positive breast cancer patients in tertiary health care center, sultanate of Oman. J Oncol Pharm Pract 2020; 27:312-321. [PMID: 32340535 DOI: 10.1177/1078155220919888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Trastuzumab, a monoclonal antibody targeting the human epidermal growth factor receptor 2 (HER2), is used to treat breast cancers harboring amplification of the HER2 locus. Cardiotoxicity is a common side effect of trastuzumab that leads to discontinuation of treatment in a significant proportion of cancer patients. In our retrospective study, we evaluate the prevalence and identify the risk factors for cardiotoxicity associated with trastuzumab in HER2-positive breast cancer patients attending to Sultan Qaboos University Hospital between 10/2012 and 10/2017. Using patient records, we collected patients' characteristics (age, menopausal status, lymph nodal status, distant metastasis at presentation, grade of tumor, comorbidities (diabetes mellitus, hypertension, coronary artery disease diseases)), chemotherapy received and total dose of trastuzumab as well as cardiotoxicity (including timing). Cardiotoxicity was defined based on the ejection fraction dropping by 10% of the original value or a drop in the ejection fraction below the normal value. Among the 146 patients included in the study, 35 showed trastuzumab-induced cardiotoxicity (24%). Twenty-nine (83%) of those patients stopped trastuzumab temporarily. Risk of trastuzumab-induced cardiotoxicity was not altered by common cardiac risk factors such as history of coronary artery disease, hypertension and diabetes. Previous anthracyclines therapy exposure increased the risk of trastuzumab-induced cardiotoxicity significantly (p = 0.009). None of the other covariates influenced the incidence of trastuzumab-induced cardiotoxicity, which may be related to the relatively small sample size. Further studies are warranted to establish ways to predict, prevent, and treat trastuzumab-induced cardiotoxicity to provide patients with maximal therapeutic benefit.
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Affiliation(s)
- Doaa Abd Alghafar
- Pharmacy Department, Sultan Qaboos University Hospital, Seeb, Oman.,School of Pharmacy, Queens University, Belfast, Northern Ireland
| | - Ibrahim Younos
- Department of Clinical Pharmacology, College of Medicine, Menoufia University, Shibin Al Kawm, Egypt.,Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Seeb, Oman
| | - Khalid Al Baimani
- Department of Medicine (Oncology Unit), Sultan Qaboos University Hospital, Seeb, Oman
| | - Dawood Al-Salhi
- Pharmacy Department, Sultan Qaboos University Hospital, Seeb, Oman
| | - Adil Al-Riyami
- Department of Medicine (Cardiology Unit), Sultan Qaboos University Hospital, Seeb, Oman
| | - Syed Rizvi
- Department of Family Medicine & Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Seeb, Oman
| | - Niamh E Buckley
- School of Pharmacy, Queens University, Belfast, Northern Ireland
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7
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Leong DP, Cosman T, Alhussein MM, Kumar Tyagi N, Karampatos S, Barron CC, Wright D, Tandon V, Magloire P, Joseph P, Conen D, Devereaux PJ, Ellis PM, Mukherjee SD, Dhesy-Thind S. Safety of Continuing Trastuzumab Despite Mild Cardiotoxicity: A Phase I Trial. JACC: CARDIOONCOLOGY 2019; 1:1-10. [PMID: 34396157 PMCID: PMC8352338 DOI: 10.1016/j.jaccao.2019.06.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/18/2019] [Accepted: 06/19/2019] [Indexed: 01/03/2023]
Abstract
Objectives This study sought to evaluate the safety of continuing trastuzumab in patients with human epidermal growth factor receptor–positive breast cancer who developed mild cardiotoxicity. Background Cardiotoxicity is the most common dose-limiting toxicity associated with trastuzumab. Current standard of care is discontinuation of trastuzumab, which can lead to worse cancer outcomes. It is unknown whether it is safe to continue trastuzumab despite mild cardiotoxicity. Methods Patients were eligible for this phase I, prospective, single-arm trial if left ventricular ejection fraction (LVEF) was between 40% and the lower limit of normal or if it fell ≥15% from baseline. Participants were treated with angiotensin-converting enzyme (ACE) inhibitors and/or beta-blockers in a cardio-oncology clinic and were followed clinically and with serial echocardiograms for 1 year. The primary outcome was cardiac dose-limiting toxicity, defined as cardiovascular death, LVEF <40% together with any heart failure symptoms, or LVEF <35%. Results All 20 participants received ACE inhibitors and/or beta-blockers. A total of 18 participants (90%) received all planned trastuzumab doses. Two (10%) participants developed cardiac dose-limiting toxicity (heart failure with LVEF <40%). Their LVEF and heart failure symptoms improved to nearly normal following permanent trastuzumab discontinuation. There were no deaths. LVEF rose progressively from a mean of 49% at enrollment to 55% at 12 months (p < 0.001). Conclusions It may be feasible to continue trastuzumab despite mild cardiotoxicity in the setting of a cardio-oncology clinic, where ACE inhibitors and beta-blockers are administered. Approximately 10% of patients may develop moderate to severe heart failure using this approach. (Safety of Continuing Chemotherapy in Overt Left Ventricular Dysfunction Using Antibodies to Human Epidermal Growth Factor Receptor-2 [SCHOLAR]; NCT02907021)
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Affiliation(s)
- Darryl P Leong
- Department of Medicine, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada.,The Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Tammy Cosman
- Department of Medicine, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Muhammad M Alhussein
- Department of Medicine, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Nidhi Kumar Tyagi
- Department of Oncology, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Sarah Karampatos
- The Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Carly C Barron
- Department of Medicine, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Douglas Wright
- Department of Medicine, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Vikas Tandon
- Department of Medicine, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Patrick Magloire
- Department of Medicine, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Philip Joseph
- Department of Medicine, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada.,The Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - David Conen
- Department of Medicine, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada.,The Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - P J Devereaux
- Department of Medicine, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada.,The Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Peter M Ellis
- Department of Oncology, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Som D Mukherjee
- Department of Oncology, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Sukhbinder Dhesy-Thind
- Department of Oncology, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
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8
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Abstract
PURPOSE OF REVIEW The main aim of this review is to address and challenge an old nomenclature of reversible versus irreversible chemotherapy-induced cardiomyopathy. RECENT FINDINGS Chemotherapy-related cardiac dysfunction (CRCD) has been often characterized as type I or type II. Type I CRCD (e.g., anthracycline) represents a group of chemotherapeutic agents that has often been correlated with irreversible cardiac dysfunction. Conversely, type II CRCD (e.g., trastuzumab) represents a group of anticancer agents that has been considered as reversible. Recent evidence suggests that this nomenclature may not hold true, thus affecting clinical prognosis as well as timely management. It is prudent to address this concern so that physicians are armed with appropriate information, thus providing our oncological patients with informed care. The purpose is to highlight the grey area in this dichotomous classification. SUMMARY Type I CRCD can be reversible if cardioprotective medications are administered in a timely manner. Conversely, a small proportion of type II CRCD may develop irreversible dysfunction and therefore, will require a long-term follow-up. Therefore, every case should be dealt on an individual basis and an appropriate prognosis should be given to patients based on the clinical evidence on hand.
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Tang GH, Acuna SA, Sevick L, Yan AT, Brezden-Masley C. Incidence and identification of risk factors for trastuzumab-induced cardiotoxicity in breast cancer patients: an audit of a single "real-world" setting. Med Oncol 2017; 34:154. [PMID: 28779423 DOI: 10.1007/s12032-017-1018-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 07/31/2017] [Indexed: 12/29/2022]
Abstract
Management of human epidermal growth factor receptor-2-positive (HER2+) breast cancer patients includes the combination of adjuvant chemotherapy and trastuzumab. A meta-analysis reported that <5% of HER2+ breast cancer patients will develop trastuzumab-induced cardiotoxicity (TIC). Observational data suggest that incidence is much higher. We aimed to determine the incidence, time to development, and risk factors associated with TIC among less selected patients. A retrospective cohort study was carried out in 160 HER2+ breast cancer patients who received adjuvant chemotherapy with trastuzumab from January 2006 to June 2014 at St. Michael's Hospital, Toronto, Canada. Patient demographics, cardiovascular history, and TIC were recorded. TIC was defined as symptomatic (heart failure) or asymptomatic [decline in left ventricular ejection fraction (LVEF) by ≥10% or LVEF ≤ 50%]. Of the 160 patients [median age 52 (IQR 45-60), 48.1% on anthracycline-based chemotherapy], 34 patients (21.3%) experienced TIC (median follow-up 55.4 months). The median time to development of TIC was 28.5 weeks during trastuzumab therapy. Those with TIC were more likely to have undergone a mastectomy (52.9 vs. 33.3%, p = 0.04). However, after adjusting for anthracycline-based chemotherapy, and radiotherapy, mastectomy was not independently associated with TIC (HR 2.02; 95% CI 0.88-4.63). The incidence of TIC is higher in our "real-world" population compared to clinical trial data. The median time to development of TIC was 28 weeks after trastuzumab initiation, approximately the 10th treatment of trastuzumab. Timely identification and management of patients is important to avoid irreversible cardiac toxicity and improve breast cancer survival.
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Affiliation(s)
- Grace H Tang
- Division of Medical Oncology, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada.
| | - Sergio A Acuna
- Division of General Surgery, St. Michael's Hospital, 30 Bond Street, Toronto, M5B 1W8, Canada
| | - Laura Sevick
- Division of Medical Oncology, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada
| | - Andrew T Yan
- Division of Cardiology, St. Michael's Hospital, 30 Bond Street, Toronto, M5B 1W8, Canada
| | - Christine Brezden-Masley
- Division of Medical Oncology, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada
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10
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Chang JS, Ko BK, Bae JW, Yu JH, Park MH, Jung Y, Jeon YW, Kim KH, Shin J, Suh CO, Kim YB. Radiation-related heart disease after breast cancer radiation therapy in Korean women. Breast Cancer Res Treat 2017; 166:249-257. [DOI: 10.1007/s10549-017-4398-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 07/11/2017] [Indexed: 12/01/2022]
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11
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Kim IH, Lee JE, Youn HJ, Song BJ, Chae BJ. Cardioprotective Effect of Dexrazoxane in Patients with HER2-Positive Breast Cancer Who Receive Anthracycline Based Adjuvant Chemotherapy Followed by Trastuzumab. J Breast Cancer 2017; 20:82-90. [PMID: 28382098 PMCID: PMC5378583 DOI: 10.4048/jbc.2017.20.1.82] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 01/31/2017] [Indexed: 12/17/2022] Open
Abstract
Purpose We intended to determine whether dexrazoxane (DZR) is cardioprotective during administration of adjuvant anthracycline-based chemotherapy followed by a 1-year trastuzumab treatment. Methods The medical records of 228 patients who underwent surgical resection and received adjuvant chemotherapy with trastuzumab for human epidermal growth factor receptor type 2 (HER2)-positive breast cancer between January 2010 and December 2014 were reviewed. Approximately 25% of patients received DZR prior to each administration of doxorubicin during doxorubicin with cyclophosphamide (AC) chemotherapy. DZR was not administered during the 1-year trastuzumab maintenance period. Rates of cardiac events (reduction in left ventricular ejection fraction [LVEF] by 10% or more; reduction in absolute LVEF to <45%) and cardiac event-free duration (CFD) were examined. The trastuzumab interruption rate was also assessed. Results Twelve percent of patients experienced a cardiac event. Repeated-measures analysis of variance for ejection fraction revealed a significant main effect of time, and a significant group (DZR)×time interaction. The group treated with adjuvant chemotherapy and DZR experienced significantly lower frequencies of cardiac events than the adjuvant chemotherapy only group. In multivariate analysis, DZR administration was associated with significantly fewer cardiac events. Moreover, DZR administration was an independent good prognostic factor for CFD. Only one patient (2.3%) experienced early interruption of trastuzumab in the adjuvant chemotherapy with DZR group due to cardiac toxicity, whereas 10 patients (7.6%) experienced a trastuzumab stop event in the adjuvant chemotherapy only group. Conclusion DZR is cardioprotective in HER2-positive breast cancer patients who received adjuvant chemotherapy with trastuzumab. A large cohort randomized trial is needed to determine if DZR has an effect on trastuzumab interruption and completion of 12-month trastuzumab. Because cardiac toxicity has a significant negative effect on trastuzumab maintenance and quality of life, DZR administration could be considered concomitantly with anthracycline-based adjuvant chemotherapy with trastuzumab.
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Affiliation(s)
- In-Ho Kim
- Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ji Eun Lee
- Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ho-Joong Youn
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Byung Joo Song
- Division of Breast-Thyroid Surgery, Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Byung Joo Chae
- Division of Breast-Thyroid Surgery, Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
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Pituskin E, Mackey JR, Koshman S, Jassal D, Pitz M, Haykowsky MJ, Pagano JJ, Chow K, Thompson RB, Vos LJ, Ghosh S, Oudit GY, Ezekowitz JA, Paterson DI. Multidisciplinary Approach to Novel Therapies in Cardio-Oncology Research (MANTICORE 101-Breast): A Randomized Trial for the Prevention of Trastuzumab-Associated Cardiotoxicity. J Clin Oncol 2016; 35:870-877. [PMID: 27893331 DOI: 10.1200/jco.2016.68.7830] [Citation(s) in RCA: 261] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose The primary toxicity of trastuzumab therapy for human epidermal growth factor receptor 2-overexpressing (HER2-positive) breast cancer is dose-independent cardiac dysfunction. Angiotensin-converting enzyme inhibitors and β-blockers are recommended first-line agents for heart failure. We hypothesized that angiotensin-converting enzyme inhibitors and β-blockers could prevent trastuzumab-related cardiotoxicity. Patients and Methods In this double-blinded, placebo-controlled trial, patients with HER2-positive early breast cancer were randomly assigned to receive treatment with perindopril, bisoprolol, or placebo (1:1:1) for the duration of trastuzumab adjuvant therapy. Patients underwent cardiac magnetic resonance imaging at baseline and post-cycle 17 for the determination of left ventricular volumes and left ventricular ejection fraction (LVEF). Cardiotoxicity was evaluated as the change in indexed left ventricular end diastolic volume and LVEF. Results Thirty-three patients received perindopril, 31 received bisoprolol, and 30 received placebo. Baseline demographic, cancer, and cardiovascular profiles were similar between groups. Study drugs were well tolerated with no serious adverse events. After 17 cycles of trastuzumab, indexed left ventricular end diastolic volume increased in patients treated with perindopril (+7 ± 14 mL/m2), bisoprolol (+8 mL ± 9 mL/m2), and placebo (+4 ± 11 mL/m2; P = .36). In secondary analyses, trastuzumab-mediated decline in LVEF was attenuated in bisoprolol-treated patients (-1 ± 5%) relative to the perindopril (-3 ± 4%) and placebo (-5 ± 5%) groups ( P = .001). Perindopril and bisoprolol use were independent predictors of maintained LVEF on multivariable analysis. Conclusion Perindopril and bisoprolol were well tolerated in patients with HER2-positive early breast cancer who received trastuzumab and protected against cancer therapy-related declines in LVEF; however, trastuzumab-mediated left ventricular remodeling-the primary outcome-was not prevented by these pharmacotherapies.
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Affiliation(s)
- Edith Pituskin
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - John R Mackey
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sheri Koshman
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Davinder Jassal
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marshall Pitz
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mark J Haykowsky
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Joseph J Pagano
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kelvin Chow
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Richard B Thompson
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Larissa J Vos
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sunita Ghosh
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gavin Y Oudit
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Justin A Ezekowitz
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - D Ian Paterson
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
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Abstract
BACKGROUND In general, cancer is a disease of aging, and palliative care is an essential step in the management of cancer in patients who are older. The goal of this article is to review common symptoms of cancer and oncology treatment and their management. METHODS The pertinent medical literature was reviewed. RESULTS The scope of palliative care includes personalized cancer treatment. This involves choosing treatment options that best fit the needs of each individual patient. Balancing treatment benefits and risks may be challenging in older patients, many of whom have limited life expectancies and decreased functional reserves. The benefits of treatment may diminish, and the risks of such treatment options increase with age. Thus, the first step toward personalized treatment includes determining physiological age, which is best estimated with a comprehensive geriatric assessment. Prevention of common complications, which include neutropenia and mucositis, allows the administration of treatment in full and effective doses. Fatigue is a chronic symptom related to cancer and its treatment and may lead to functional dependence and an increased risk of death. Fatigue might be prevented by daily exercise even during treatment. Other symptoms include pain and feelings of memory loss. CONCLUSIONS The scope of palliative care encompasses more issues that symptom management and, for this reason, palliative care should be provided once the diagnosis of cancer is established. Determining treatment goals is essential to improve the treatment experience. Symptom management is similar in older and young patients, but symptoms in the older population may be associated with more frequent and severe complications. Many options exist to prevent and ameliorate the complications of oncology treatment in the aged. However, more studies should be conducted on the long-term care of older patients who have survived cancer.
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Guenancia C, Lefebvre A, Cardinale D, Yu AF, Ladoire S, Ghiringhelli F, Zeller M, Rochette L, Cottin Y, Vergely C. Obesity As a Risk Factor for Anthracyclines and Trastuzumab Cardiotoxicity in Breast Cancer: A Systematic Review and Meta-Analysis. J Clin Oncol 2016; 34:3157-65. [PMID: 27458291 PMCID: PMC5569689 DOI: 10.1200/jco.2016.67.4846] [Citation(s) in RCA: 135] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Patients with metabolic syndrome have a greater risk of cardiovascular disease, although their susceptibility to chemotherapy-induced cardiac disease is not well documented. The aim of this meta-analysis was to assess associations between obesity or being overweight and cardiotoxicity from anthracyclines and sequential anthracyclines and trastuzumab in patients with breast cancer. METHODS We performed a random-effects analysis and a network meta-analysis and assessed publication bias. We included 15 studies and 8,745 patients with breast cancers who were treated with anthracyclines and sequential anthracyclines and trastuzumab. RESULTS Combination of obesity and being overweight was significantly associated with a greater risk of developing cardiotoxicity after anthracyclines and a sequential anthracyclines and trastuzumab regimen in patients with breast cancer. Pooled odds ratio for cardiotoxicity was 1.38 (95% CI, 1.06 to 1.80; I(2) = 43%; N = 8,745) for overweight or obesity (body mass index > 25 kg/m(2)), 1.47 (95% CI, 0.95 to 2.28; I(2) = 47%; n = 2,615) for obesity, and 1.15 (95% CI, 0.83 to 1.58; I(2) = 27%; n = 2,708) for overweight. Associations were independent of study design, year of publication, drug regimen (anthracyclines alone v sequential anthracyclines and trastuzumab), or definitions of cardiotoxicity and of overweight or obesity. There was no evidence of publication bias; however, we could not separate the contributions of obesity-related cardiovascular risk factors, such as diabetes and hypertension, from that of obesity itself in this largely unadjusted analysis. CONCLUSION Our findings in a largely unadjusted analysis suggest that overweight and obesity are risk factors for cardiotoxicity from anthracyclines and sequential anthracyclines and trastuzumab.
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Affiliation(s)
- Charles Guenancia
- Charles Guenancia, Annick Lefebvre, and Yves Cottin, University Hospital; Charles Guenancia, Marianne Zeller, Luc Rochette, Yves Cottin, and Catherine Vergely, Institut National de la Santé et de la Recherche Médicale, U866, Laboratoire de Physiopathologie et Pharmacologie Cardio-Métaboliques; Sylvain Ladoire and François Ghiringhelli, Georges François Leclerc Cancer Center; Sylvain Ladoire and François Ghiringhelli, Institut National de la Santé et de la Recherche Médicale, CRI-866, University of Burgundy, Dijon; Annick Lefebvre, University Hospital, Reims, France; Daniela Cardinale, European Institute of Oncology, Milan, Italy; and Anthony F. Yu, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Annick Lefebvre
- Charles Guenancia, Annick Lefebvre, and Yves Cottin, University Hospital; Charles Guenancia, Marianne Zeller, Luc Rochette, Yves Cottin, and Catherine Vergely, Institut National de la Santé et de la Recherche Médicale, U866, Laboratoire de Physiopathologie et Pharmacologie Cardio-Métaboliques; Sylvain Ladoire and François Ghiringhelli, Georges François Leclerc Cancer Center; Sylvain Ladoire and François Ghiringhelli, Institut National de la Santé et de la Recherche Médicale, CRI-866, University of Burgundy, Dijon; Annick Lefebvre, University Hospital, Reims, France; Daniela Cardinale, European Institute of Oncology, Milan, Italy; and Anthony F. Yu, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniela Cardinale
- Charles Guenancia, Annick Lefebvre, and Yves Cottin, University Hospital; Charles Guenancia, Marianne Zeller, Luc Rochette, Yves Cottin, and Catherine Vergely, Institut National de la Santé et de la Recherche Médicale, U866, Laboratoire de Physiopathologie et Pharmacologie Cardio-Métaboliques; Sylvain Ladoire and François Ghiringhelli, Georges François Leclerc Cancer Center; Sylvain Ladoire and François Ghiringhelli, Institut National de la Santé et de la Recherche Médicale, CRI-866, University of Burgundy, Dijon; Annick Lefebvre, University Hospital, Reims, France; Daniela Cardinale, European Institute of Oncology, Milan, Italy; and Anthony F. Yu, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anthony F Yu
- Charles Guenancia, Annick Lefebvre, and Yves Cottin, University Hospital; Charles Guenancia, Marianne Zeller, Luc Rochette, Yves Cottin, and Catherine Vergely, Institut National de la Santé et de la Recherche Médicale, U866, Laboratoire de Physiopathologie et Pharmacologie Cardio-Métaboliques; Sylvain Ladoire and François Ghiringhelli, Georges François Leclerc Cancer Center; Sylvain Ladoire and François Ghiringhelli, Institut National de la Santé et de la Recherche Médicale, CRI-866, University of Burgundy, Dijon; Annick Lefebvre, University Hospital, Reims, France; Daniela Cardinale, European Institute of Oncology, Milan, Italy; and Anthony F. Yu, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sylvain Ladoire
- Charles Guenancia, Annick Lefebvre, and Yves Cottin, University Hospital; Charles Guenancia, Marianne Zeller, Luc Rochette, Yves Cottin, and Catherine Vergely, Institut National de la Santé et de la Recherche Médicale, U866, Laboratoire de Physiopathologie et Pharmacologie Cardio-Métaboliques; Sylvain Ladoire and François Ghiringhelli, Georges François Leclerc Cancer Center; Sylvain Ladoire and François Ghiringhelli, Institut National de la Santé et de la Recherche Médicale, CRI-866, University of Burgundy, Dijon; Annick Lefebvre, University Hospital, Reims, France; Daniela Cardinale, European Institute of Oncology, Milan, Italy; and Anthony F. Yu, Memorial Sloan Kettering Cancer Center, New York, NY
| | - François Ghiringhelli
- Charles Guenancia, Annick Lefebvre, and Yves Cottin, University Hospital; Charles Guenancia, Marianne Zeller, Luc Rochette, Yves Cottin, and Catherine Vergely, Institut National de la Santé et de la Recherche Médicale, U866, Laboratoire de Physiopathologie et Pharmacologie Cardio-Métaboliques; Sylvain Ladoire and François Ghiringhelli, Georges François Leclerc Cancer Center; Sylvain Ladoire and François Ghiringhelli, Institut National de la Santé et de la Recherche Médicale, CRI-866, University of Burgundy, Dijon; Annick Lefebvre, University Hospital, Reims, France; Daniela Cardinale, European Institute of Oncology, Milan, Italy; and Anthony F. Yu, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Marianne Zeller
- Charles Guenancia, Annick Lefebvre, and Yves Cottin, University Hospital; Charles Guenancia, Marianne Zeller, Luc Rochette, Yves Cottin, and Catherine Vergely, Institut National de la Santé et de la Recherche Médicale, U866, Laboratoire de Physiopathologie et Pharmacologie Cardio-Métaboliques; Sylvain Ladoire and François Ghiringhelli, Georges François Leclerc Cancer Center; Sylvain Ladoire and François Ghiringhelli, Institut National de la Santé et de la Recherche Médicale, CRI-866, University of Burgundy, Dijon; Annick Lefebvre, University Hospital, Reims, France; Daniela Cardinale, European Institute of Oncology, Milan, Italy; and Anthony F. Yu, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Luc Rochette
- Charles Guenancia, Annick Lefebvre, and Yves Cottin, University Hospital; Charles Guenancia, Marianne Zeller, Luc Rochette, Yves Cottin, and Catherine Vergely, Institut National de la Santé et de la Recherche Médicale, U866, Laboratoire de Physiopathologie et Pharmacologie Cardio-Métaboliques; Sylvain Ladoire and François Ghiringhelli, Georges François Leclerc Cancer Center; Sylvain Ladoire and François Ghiringhelli, Institut National de la Santé et de la Recherche Médicale, CRI-866, University of Burgundy, Dijon; Annick Lefebvre, University Hospital, Reims, France; Daniela Cardinale, European Institute of Oncology, Milan, Italy; and Anthony F. Yu, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yves Cottin
- Charles Guenancia, Annick Lefebvre, and Yves Cottin, University Hospital; Charles Guenancia, Marianne Zeller, Luc Rochette, Yves Cottin, and Catherine Vergely, Institut National de la Santé et de la Recherche Médicale, U866, Laboratoire de Physiopathologie et Pharmacologie Cardio-Métaboliques; Sylvain Ladoire and François Ghiringhelli, Georges François Leclerc Cancer Center; Sylvain Ladoire and François Ghiringhelli, Institut National de la Santé et de la Recherche Médicale, CRI-866, University of Burgundy, Dijon; Annick Lefebvre, University Hospital, Reims, France; Daniela Cardinale, European Institute of Oncology, Milan, Italy; and Anthony F. Yu, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Catherine Vergely
- Charles Guenancia, Annick Lefebvre, and Yves Cottin, University Hospital; Charles Guenancia, Marianne Zeller, Luc Rochette, Yves Cottin, and Catherine Vergely, Institut National de la Santé et de la Recherche Médicale, U866, Laboratoire de Physiopathologie et Pharmacologie Cardio-Métaboliques; Sylvain Ladoire and François Ghiringhelli, Georges François Leclerc Cancer Center; Sylvain Ladoire and François Ghiringhelli, Institut National de la Santé et de la Recherche Médicale, CRI-866, University of Burgundy, Dijon; Annick Lefebvre, University Hospital, Reims, France; Daniela Cardinale, European Institute of Oncology, Milan, Italy; and Anthony F. Yu, Memorial Sloan Kettering Cancer Center, New York, NY
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Liu M, Li Z, Yang J, Jiang Y, Chen Z, Ali Z, He N, Wang Z. Cell-specific biomarkers and targeted biopharmaceuticals for breast cancer treatment. Cell Prolif 2016; 49:409-20. [PMID: 27312135 PMCID: PMC6496337 DOI: 10.1111/cpr.12266] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 05/04/2016] [Indexed: 12/13/2022] Open
Abstract
Breast cancer is the second leading cause of cancer death among women, and its related treatment has been attracting significant attention over the past decades. Among the various treatments, targeted therapy has shown great promise as a precision treatment, by binding to cancer cell-specific biomarkers. So far, great achievements have been made in targeted therapy of breast cancer. In this review, we first discuss cell-specific biomarkers, which are not only useful for classification of breast cancer subtyping but also can be utilized as goals for targeted therapy. Then, the innovative and generic-targeted biopharmaceuticals for breast cancer, including monoclonal antibodies, non-antibody proteins and small molecule drugs, are reviewed. Finally, we provide our outlook on future developments of biopharmaceuticals, and provide solutions to problems in this field.
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Affiliation(s)
- Mei Liu
- School of Biological Science and Medical EngineeringSoutheast UniversityNanjingChina
| | - Zhiyang Li
- School of Biological Science and Medical EngineeringSoutheast UniversityNanjingChina
- Department of Laboratory MedicineNanjing Drum Tower Hospital Clinical CollegeNanjing UniversityNanjingChina
| | - Jingjing Yang
- School of Chemistry and Chemical EngineeringSoutheast UniversityNanjingChina
| | - Yanyun Jiang
- School of Chemistry and Chemical EngineeringSoutheast UniversityNanjingChina
| | - Zhongsi Chen
- School of Biological Science and Medical EngineeringSoutheast UniversityNanjingChina
| | - Zeeshan Ali
- School of Chemistry and Chemical EngineeringSoutheast UniversityNanjingChina
| | - Nongyue He
- School of Biological Science and Medical EngineeringSoutheast UniversityNanjingChina
| | - Zhifei Wang
- School of Chemistry and Chemical EngineeringSoutheast UniversityNanjingChina
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Chandrika BB, Steephan M, Kumar TRS, Sabu A, Haridas M. Hesperetin and Naringenin sensitize HER2 positive cancer cells to death by serving as HER2 Tyrosine Kinase inhibitors. Life Sci 2016; 160:47-56. [PMID: 27449398 DOI: 10.1016/j.lfs.2016.07.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 07/08/2016] [Accepted: 07/18/2016] [Indexed: 11/24/2022]
Abstract
AIM Aberrant human epidermal growth factor receptor-2 (HER2) expression and constitutive mutant activation of its tyrosine kinase domain account for tumor aggression and therapy resistance in many types of cancers with major share in breast cancer cases. HER2 specific treatment modalities still face challenges owing to the side effects and acquired resistance of available therapeutics. Recently, the anti-proliferative and pro-apoptotic potential of phytochemicals, especially of flavonoids have become increasingly appreciated as powerful chemo preventive agents. Consequently, the major goal of our study is to identify flavonoids capable of inhibiting HER2 Tyrosine Kinase (HER2-TK) activity and validate their anti-tumor activity against HER2 positive tumors. MAIN METHODS Molecular docking studies for identifying flavonoids binding at HER2 kinase domain, ADP-Glo™ Kinase Assay for determining kinase activity, MTT assay to measure growth inhibition, various apoptotic assays and cell cycle analysis by FACS were performed. KEY FINDINGS Among the flavonoids screened, Naringenin (NG) and Hesperetin (HP) possessed high glide scores from molecular docking studies of enzyme-inhibitor mode. The interaction analysis revealed their ability to establish stable and strong interaction at the ATP binding site of HER2-TK. These compounds also inhibited in vitro HER2-TK activity suggesting their role as HER2 inhibitors. The study also unraveled the anti-proliferative, pro-apoptotic and anti-cancerous activity of these flavonoids against HER2 positive breast cancer cell line. SIGNIFICANCE The study identified two citrus fruit flavonoids, NG and HP as HER2-TK inhibitors and this is the first report on their potential to target preferentially and sensitize HER2 positive cancer cells to cell death.
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Affiliation(s)
- Bhavya Balan Chandrika
- Inter University Centre for Bioscience and Department of Biotechnology & Microbiology, Kannur University Thalassery Campus, Kannur 670 661, Kerala, India.
| | - Mathew Steephan
- Govt Brennen College, Kannur University, Kannur 670 661, Kerala, India
| | | | - A Sabu
- Inter University Centre for Bioscience and Department of Biotechnology & Microbiology, Kannur University Thalassery Campus, Kannur 670 661, Kerala, India
| | - M Haridas
- Inter University Centre for Bioscience and Department of Biotechnology & Microbiology, Kannur University Thalassery Campus, Kannur 670 661, Kerala, India.
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Grazziotin LR, Picon PD. Observational study of trastuzumab-related cardiotoxicity in early and metastatic breast cancer. J Oncol Pharm Pract 2016; 23:264-272. [PMID: 26983449 DOI: 10.1177/1078155216639755] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Trastuzumab-related cardiotoxicity has been a major concern in clinical practice, since observational studies have shown higher incidences than that reported in clinical trials. We aim to measure the incidence of trastuzumab-related cardiotoxicity in patients with early and metastatic breast cancer in the south of Brazil. Methods Multicenter prospective observational study, which included 109 patients with early or metastatic HER-2+ breast cancer undergoing any trastuzumab-based regimen. Cardiac events were measured by transthoracic echocardiography assessments and by signs and symptoms of heart failure. Results Trastuzumab-related cardiotoxicity was observed in 58 patients (53.2%). Emergency and hospitalization admissions were necessary in seven and three patients, respectively, due to symptoms of heart failure. One patient died in consequence of trastuzumab-related cardiotoxicity. In total, trastuzumab was discontinued in 31.2% of patients, of which almost a third could not return to treatment. In this study, no risk factors were significantly associated with the development of cardiotoxicity. Discussion The incidence of TRC and trastuzumab's early discontinuation observed was significantly higher in comparison with other studies. These findings endorse the fact that trastuzumab-related cardiotoxicity is a relevant adverse reaction, and therefore, cardiac dysfunction's monitoring must be highlighted in order to allow a safe use of trastuzumab in this population.
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Affiliation(s)
- L R Grazziotin
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - P D Picon
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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