by Rita De Sanctis, Laura Giordano, Federica D’Antonio,
Elisa Agostinetto, Arianna Marinello, Daniela Guiducci, Giovanna Masci, Agnese
Losurdo, Monica Zuradelli, Rosalba Torrisi, Armando Santoro
The Breast: VOLUME 57, P80-85, JUNE
01, 2021 (Published: March 17, 2021)
Background
Few data are available about real-life cardiotoxicity
associated with s.c. versus i.v. trastuzumab treatment of
early-stage, HER2-positive breast cancer, and little is known about its
predisposing factors.
Patients and methods
We retrospectively reviewed data of 363 adult patients
treated with adjuvant trastuzumab for HER2-positive breast cancer. Univariate
statistical analysis was performed, and a multivariable logistic model was
developed to identify independent risk factors of cardiac toxicity.
Results
Within 5 years, the overall incidence of events meeting our
criteria was 11.8%, and an early discontinuation of trastuzumab was recorded in
20 patients (5.5%). No cases of congestive heart failure occurred, neither
multiple events per patient were observed. A total of 184 patients received i.v.
and 179 received s.c. trastuzumab. Compared with the s.c. formulation, a higher
cardiotoxicity rate for the i.v. administration (15.2% vs 8.4%) was
found, and particularly in those patients with cardiovascular risk factors
(19.3% vs 8.7%), at the univariate and multivariate analyses.
Although more patients with prior anthracycline-based chemotherapy experienced
cardiac events, the association of this therapy with cardiac events was not
significant. The incidence of cardiac events was not influenced by anthropometric
data (e.g. body mass index) or a diagnosis of diabetes mellitus. 5-year
event-free survival was 91.7% in the overall population; event-free survival
rates were similar between the s.c. and the i.v. groups.
Conclusion
Our study shows a more favorable safety profile of
s.c. versus i.v trastuzumab administration. The use of s.c.
trastuzumab could be advisable in at-risk patients.
