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Obesity Increases Risk for Trastuzumab-Induced Cardiotoxicity: Presented at ASBD

By Peggy Peck

BOSTON, MA -- April 29, 2004 -- Obese women may be more likely to develop trastuzumab-induced cardiac dysfunction, suggest results presented here on April 24^th at the American Society of Breast Disease (ASBD) 28^th Annual Symposium.

The finding, according to Barry Lambersky, MD, clinical associate professor, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania, should be regarded as a "cautionary flag."

Dr. Lambersky said the findings will need to be confirmed, "which could easily be done in any of the ongoing prospective trastuzumab adjuvant studies. But by itself, this study underscores the need for careful cardiac evaluation of this drug in obese women."

Dr. Lambersky, who was not involved in the study but served as ASBD discussant for the poster, said the study also identified hyperlipidemia as a risk factor for trastuzumab-associated cardiotoxicity.

Deepjot Singh, MD, University Hospitals of Cleveland, Cleveland, Ohio, and colleagues at Ireland Cancer Center and Case Western Reserve University reviewed the medical records of 105 patients who received trastuzumab between October 1998 and October 2002. The researchers assessed patients for cardiovascular risk factors including age, history of cardiovascular disease, hyperlipidemia, hypertension, diabetes, smoking, obesity and radiation to the mammary lymph nodes. They also used New York Heart Association functional classification system to document clinical severity of cardiovascular disease.

Among women treated with trastuzumab and vinorelbine chemotherapy, 29% had cardiovascular disease, while with trastuzumab monotherapy the heart disease incidence was 5.7%. Asymptomatic decreases in left ventricular ejection fraction (LVEF) were seen in 13.8% of cases.

Obesity was associated with a significantly higher incidence of congestive heart failure (odds ratio [OR] 3.98; P = .005) and hyperlipidemia was associated with a 10% decrease in LVEF (OR 9.74; P = .012), although this decrease in function was asymptomatic.

The authors concluded that the combination of trastuzumab with vinorelbine resulted in a four-fold increase in asymptomatic cardiac dysfunction (OR 3.81; P = .045).


[Presentation title: Trastuzumab-Associated Cardiac Dysfunction. Poster #12]

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