Cardiac Effect of Trastuzumab on Breast Cancer Women at Oncology Teaching Hospital / in Baghdad, Iraq

Abstract

Breast cancer is first of the top ten malignancies in Iraq, accounting more than one-quarter of female
cancers in the Iraqi. Treatment of cardiotoxicity induced by trastuzumab significantly reducing the clinical
manifestations of cardiac dysfunction. The study aimed to described human epidermal growth factor
receptor 2 positive non metastatic breast cancer among Iraqi female patients, and analyzed of cardiac
monitoring by echocardiograph studies in their adjuvant setting. In addition, assessment of cardiac adverse
effects related to trastuzumab treatment. A retrospective longitudinal study of 142 non-metastatic breast
cancer females were included, at Oncology Teaching hospital/ Medical City Teaching Complex, Baghdad,
Iraq, from 1 December 2018 to 30 November 2019. The adequacy of cardiac monitoring was determined
by echocardiograph study at first setting before first dose of trastuzumab, 12 weeks , and 24 weeks sequel.
The mean women age of the study was 53.54±10.058 years with median age of 54.5 years. The mean was
1.81±0.34 m2
 with median of 1.65 m2
. Regarding BMI, the mean was 30.62±5.51 m2
/Kg with median of
30.05 m2
/Kg. The most common stage of breast cancer in the study was stage IIIA 33(24.6%) patients,
followed by stage IIA 31(23.1%) patients, and stage IIB 30(22.4%) patients. Regarding TNM staging of
breast cancer, the tumor size 20 – 50 mm (T2) stage was common 94(70.1%), and the results showed a high
frequency of no lymph node metastasis (N0) staging in 49(36.8%). Anthracyclin AC protocol given to
117(82.3%) patients, and taxen given to 113(79.5%) patients. A total of 106(74.6%) of women underwent
mastectomy, while the rest 36(25.4%) underwent breast conservative surgery. Women received
radiotherapy were 81(57.7%), whereas 60(42.3%) weren’t. Hormonal therapy like Aromatase inhibitors
received by 20(14.1%) patients, while 49(34.5%) of females were on tamoxifen. Most of females
134(92.2%), received trastuzumab as 17 doses (dose every 21 days for one year duration). 8(5.6%) females
stopped trastuzumab and didn’t complete protocol due to developing of cardiac toxicity after 6; 7; 8; 10;
11, doses. Baseline cardiac evaluation was performed in 139(97.8%) of patients by echocardiography 1;
141(99.3%) had an echocardiography 2 study within the first 12 weeks of trastuzumab therapy, and
138(97.2%) of patients done echocardiography 3 study at 24 weeks of therapy. Normal echocardiograph 1
study in 123(86.6%) patients were ejection fraction (EF) =55-70%. Normal EF% (>55%) plus abnormal
findings presented in 14(9.8%), 30(21.1%), and 27(19%) of patients. The abnormal EF% (50%) plus
abnormal findings noticed in 1(0.7%), 3(2.1%), and 3(2.1%) patients. Abnormal EF% (<50%; 40%; 30%;
<30%) plus abnormal findings were observed 1(0.7%), 9(6.3%), and 14(9.8) of patients, with strongly
significant reduction rate 41.7% in EF% at (p<0.000). Cardiac assessment, and heart function
measurement, including EF measurement, performing before chemotherapy is a baseline guide in frequent
assessment in the future. Cardiac risk factors management like hypertension before the first cycle of
chemotherapy is mandatory. Reassessment of EF after completing chemotherapy and before starting
trastuzumab, and repeat measurements throughout therapy is of great value in preventing decline in health
status.