AlphaMed Release: Therapeutic Combination for HER2-Positive Breast Cancer Does Not Increase Cardiac Problems, but Cancer Patients' Heart Health Should be Monitored
HER2 – a type of protein found in more aggressive types of breast cancer – is commonly treated with trastuzumab, which has been associated with certain types of cardiac dysfunction. A newer therapy, pertuzumab had undergone limited testing for cardiac safety both alone and in combination with trastuzumab, but Dr. Swain’s study, called CLEOPATRA, was the first phase III trial to study the use of trastuzumab, pertuzumab and docetaxel in patients with HER2-positive metastatic breast cancer receiving first-line treatment.
A randomized, double-blind trial in which some patients received a placebo instead of pertuzumab, CLEOPATRA produced efficacy results that led the FDA last year to approve using a combination of trastuzumab, pertuzumab and docetaxel to treat HER2-positive metastatic breast cancer. As part of this study, Dr. Swain and colleagues examined more than 800 patients’ cardiac incidences during treatment and up to three years after treatment, finding that the drug combination did not contribute to increased heart problems.
“The overall incidence of cardiac adverse effects was low; importantly, the combination of pertuzumab with trastuzumab and docetaxel did not increase the incidence of cardiac adverse effects compared with the placebo arm,” Dr. Swain said.
Researchers used echocardiography or multiple-gated acquisition scanning (MUGA) to assess patients’ left ventricular ejection fraction (LVEF) before treatment, at 9-week intervals during treatment, and once or twice a year after treatment. Adverse cardiac events were reported and graded. Left ventricular systolic dysfunction (LVSD) was the most frequently reported cardiac event, and the majority of cardiac adverse effects were reversible and clinically manageable.
As additional, longer-term data regarding the cardiac impact of this combination therapy continue to be collected, Dr. Swain and colleagues recommend that routine cardiac monitoring of cancer patients be conducted in clinical practice, such as measuring LVEF before the treatment regimen and in 3-month intervals during treatment. Noting the predictive limitations of echocardiograms and MUGA, they also recommended that the optimal schedule for longer-term monitoring should be established in a clinical environment.
“Dr. Swain's analysis of a major breast cancer clinical trial provides fundamental guidance for the treatment of breast cancer patients in which efficacy is maximized and heart toxicities are greatly reduced or eliminated. As such, this is a vital advance by a global leader in oncology,” said Dr, Martin J. Murphy, Jr., Executive Editor of The Oncologist.
The full article, titled “Cardiac Tolerability of Pertuzumab Plus Trastuzumab Plus Docetaxel in Patients with HER2-Positive Metastatic Breast Cancer in CLEOPATRA: A Randomized, Double-Blind, Placebo-Controlled Phase III Study,” can be accessed at www.TheOncologist.com.
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