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Monitoring the introduction of new drugs – Herceptin to cardiotoxicity

HC Routledge, DW Rea and RP Steeds
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DOI: https://doi.org/10.7861/clinmedicine.6-5-478
Clin Med September 2006
HC Routledge
1Department of Cardiology, University of Birmingham
Roles: Specialist Registrar in Cardiology
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DW Rea
2Institute for Cancer Studies, Queen Elizabeth Hospital, Birmingham
Roles: Senior Lecturer in Medical Oncology
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RP Steeds
1Department of Cardiology, University of Birmingham
Roles: Consultant Cardiologist
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Abstract

Trastuzumab (Herceptin), currently prescribed for metastatic breast cancer, has recently been shown to be effective as adjuvant therapy in early receptor 2 (HER2)-positive breast cancer. Cardiotoxicity is a serious adverse effect. A decrease in left ventricular ejection fraction (LVEF) occurs in as many as 27% of women treated with trastuzumab when combined with standard chemotherapy. The pathophysiology of this effect, which differs from the cardiotoxicity of anthracyclines, remains poorly understood. While overt heart failure is reversed with standard therapy, the longer-term consequences of asymptomatic declines in LVEF remain unknown. Monitoring 3-monthly for 5–10% changes in LVEF, the criteria for cessation of trastuzumab therapy in the clinical trials, is not possible for the population of women who might benefit from trastuzumab for early breast cancer. Extension of this therapy to an older and less fit population than those enrolled in the trials, with less rigorous cardiac screening, may result in significantly more cardiotoxicity.

Key Words
  • breast cancer
  • cardiac failure
  • cardiotoxicity
  • echocardiography
  • trastuzumab (Herceptin)
  • © 2006 Royal College of Physicians
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Monitoring the introduction of new drugs
HC Routledge, DW Rea, RP Steeds
Clinical Medicine Sep 2006, 6 (5) 478-481; DOI: 10.7861/clinmedicine.6-5-478

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Monitoring the introduction of new drugs
HC Routledge, DW Rea, RP Steeds
Clinical Medicine Sep 2006, 6 (5) 478-481; DOI: 10.7861/clinmedicine.6-5-478
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