1. ¹Division of Medical Oncology, University Hospital, Via del Pozzo, 71-41100 Modena, Italy
2. ²Division of Medical Oncology, S. Orsola-Malpighi Hospital, Bologna, Italy
3. ³Division of Medical Oncology, Niguarda Hospital, Milan, Italy
4. ⁴Division of Medical Oncology, National Cancer Institute, Milan, Italy
5. ⁵S. Martino University Hospital, Genoa, Italy
6. ⁶Division of Medical Oncology, Maugeri Cancer Foundation, Pavia, Italy
7. ⁷Bone Marrow Transplantation Unit, Civic Hospital, Reggio Calabria, Italy
8. ⁸Division of Medical Oncology, Civic Hospital, Ravenna, Italy
9. ⁹Division of Medical Oncology, University Hospital, Pavia, Italy
10. ¹⁰Bone Marrow Transplantation Unit, S. Raffaele Hospital, Milan, Italy

Correspondence: Dr C Bengala, E-mail: bengala.carmelo@policlinico.mo.it

Received 27 January 2006; Revised 23 February 2006; Accepted 23 February 2006; Published online 28 March 2006.

Abstract

HER-2 overexpression is associated to a poor prognosis in high-risk and metastatic breast cancer (MBC) patients treated with high-dose chemotherapy (HDC). HER-2 status is also a predictive factor and when trastuzumab is administered in combination with or sequentially to chemotherapy, a significant disease-free and/or overall survival improvement has been observed in HER-2+ early and MBC. Unfortunately, in both settings, trastuzumab is associated with an increased risk of cardiac dysfunction (CD). We have reviewed the clinical charts of HER-2-overexpressing MBC patients treated with trastuzumab after HDC. Age, baseline left ventricular ejection fraction (LVEF), radiation therapy on cardiac area, exposure to anthracycline, single or multiple transplant, high-dose agents, trastuzumab treatment duration were recorded as potential risk factors. In total, 53 patients have been included in the analysis. Median LVEF at baseline was 60.5%; at the end of trastuzumab (data available for 28 patients only), it was 55% (P=0.01). Five out of the 28 (17.9%) patients experienced CD. Two out of 53 (3.8%) patients developed a congestive heart failure. Age 50 years and multiple transplant procedure were potential risk factors for CD. The overall incidence of CD observed in this population of HER-2+ MBC patients treated with trastuzumab after HDC is not superior to that reported with concomitant trastuzumab and anthracyclines. However, patients with age 50 years or receiving multiple course of HDC should be considered at risk for CD.