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Kim IH, Lee JE, Youn HJ, et al. 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(1):82-90doi: 10.4048/jbc.2017.20.1.82.
Kim, I. H., Lee, J. E., Youn, H. J., Song, B. J., & Chae, B. J. (2017). Cardioprotective Effect of Dexrazoxane in Patients with HER2-Positive Breast Cancer Who Receive Anthracycline Based Adjuvant Chemotherapy Followed by Trastuzumab. Journal of breast cancer, 20(1), 82-90. https://doi.org/10.4048/jbc.2017.20.1.82
Kim, In-Ho, et al. "Cardioprotective Effect of Dexrazoxane in Patients with HER2-Positive Breast Cancer Who Receive Anthracycline Based Adjuvant Chemotherapy Followed by Trastuzumab." Journal of breast cancer vol. 20,1 (2017): 82-90. doi: https://doi.org/10.4048/jbc.2017.20.1.82
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 Mar;20(1):82-90. doi: 10.4048/jbc.2017.20.1.82. Epub 2017 Mar 24. PMID: 28382098; PMCID: PMC5378583.
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J Breast Cancer. 2017 Mar;20(1):82-90. doi: 10.4048/jbc.2017.20.1.82. Epub 2017 Mar 24.

Cardioprotective Effect of Dexrazoxane in Patients with HER2-Positive Breast Cancer Who Receive Anthracycline Based Adjuvant Chemotherapy Followed by Trastuzumab.

Journal of breast cancer

In-Ho Kim, Ji Eun Lee, Ho-Joong Youn, Byung Joo Song, Byung Joo Chae

Affiliations

  1. Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.
  2. Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.
  3. Division of Breast-Thyroid Surgery, Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.

PMID: 28382098 PMCID: PMC5378583 DOI: 10.4048/jbc.2017.20.1.82

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.

Keywords: Adjuvant chemotherapy; Breast neoplasms; Cardiotoxicity; Dexrazoxane; Trastuzumab

Conflict of interest statement

CONFLICT OF INTEREST: The authors declare that they have no competing interests.

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