| Trastuzumab-induced cardiotoxicity: clinical and prognostic implications of troponin I evaluation. | |
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MedLine Citation:
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PMID: 20679614 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE: Treatment of breast cancer with trastuzumab is complicated by cardiotoxicity in up to 34% of the patients. In most patients, trastuzumab-induced cardiotoxicity (TIC) is reversible: left ventricular ejection fraction (LVEF) improves after trastuzumab withdrawal and with, or sometimes without, initiation of heart failure (HF) therapy. The reversibility of TIC, however, is not foreseeable, and identification of patients at risk and of those who will not recover from cardiac dysfunction is crucial. The usefulness of troponin I (TNI) in the identification of patients at risk for TIC and in the prediction of LVEF recovery has never been investigated. PATIENTS AND METHODS: In total, 251 women were enrolled. TNI was measured before and after each trastuzumab cycle. LVEF was evaluated at baseline, every 3 months during trastuzumab therapy, and every 6 months afterward. In case of TIC, trastuzumab was discontinued, and HF treatment with enalapril and carvedilol was initiated. TIC was defined as LVEF decrease of > 10 units and below 50%. Recovery from TIC was defined as LVEF increase above 50%. RESULTS: TIC occurred in 42 patients (17%) and was more frequent in patients with TNI elevation (TNI+; 62% v 5%; P < .001). Twenty-five patients (60%) recovered from TIC. LVEF recovery occurred less frequently in TNI+ patients (35% v 100%; P < .001). At multivariate analysis, TNI+ was the only independent predictor of TIC (hazard ratio [HR], 22.9; 95% CI, 11.6 to 45.5; P < .001) and of lack of LVEF recovery (HR, 2.88; 95% CI,1.78 to 4.65; P < .001). CONCLUSION: TNI+ identifies trastuzumab-treated patients who are at risk for cardiotoxicity and are unlikely to recover from cardiac dysfunction despite HF therapy. |
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Authors:
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Daniela Cardinale; Alessandro Colombo; Rosalba Torrisi; Maria T Sandri; Maurizio Civelli; Michela Salvatici; Giuseppina Lamantia; Nicola Colombo; Sarah Cortinovis; Maria A Dessanai; Franco Nolè; Fabrizio Veglia; Carlo M Cipolla |
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Publication Detail:
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Type: Evaluation Studies; Journal Article Date: 2010-08-02 |
Journal Detail:
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Title: Journal of clinical oncology : official journal of the American Society of Clinical Oncology Volume: 28 ISSN: 1527-7755 ISO Abbreviation: J. Clin. Oncol. Publication Date: 2010 Sep |
Date Detail:
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Created Date: 2010-08-31 Completed Date: 2010-10-06 Revised Date: 2011-04-05 |
Medline Journal Info:
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Nlm Unique ID: 8309333 Medline TA: J Clin Oncol Country: United States |
Other Details:
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Languages: eng Pagination: 3910-6 Citation Subset: IM |
Affiliation:
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Cardiology Unit, European Institute of Oncology, Milan, Italy. daniela.cardinale@ieo.it |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Antibodies, Monoclonal / adverse effects* Antineoplastic Combined Chemotherapy Protocols / therapeutic use Breast Neoplasms / drug therapy*, metabolism* Drug Interactions Female Heart Diseases / chemically induced* Humans Middle Aged Prognosis Retrospective Studies Risk Treatment Outcome Troponin I / metabolism* Ventricular Dysfunction, Left / chemically induced |
| Chemical | |
Reg. No./Substance:
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0/Antibodies, Monoclonal; 0/Troponin I; 0/trastuzumab |
| Comments/Corrections | |
Comment In:
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J Clin Oncol. 2010 Sep 1;28(25):3901-4
[PMID:
20679626
]
J Clin Oncol. 2010 Dec 20;28(36):e769 [PMID: 21079139 ] J Clin Oncol. 2011 Mar 1;29(7):e175-6 [PMID: 21189375 ] J Clin Oncol. 2011 Mar 1;29(7):e177; author reply e178-9 [PMID: 21189389 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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