Abstract
A meta-analysis of cardiac toxicity of concurrent epirubicin and trastuzumab in early breast cancer.
Author
person
Minghan Yang
National Taiwan University Hospital Hsinchu branch, Hsinchu City, Taiwan
info_outline
Minghan Yang, Chiun-Sheng Huang, Dwan-Ying Chang, I-Chun Chen, Ching-Hung Lin, Yen-Shen Lu
Full text
Authors
person
Minghan Yang
National Taiwan University Hospital Hsinchu branch, Hsinchu City, Taiwan
info_outline
Minghan Yang, Chiun-Sheng Huang, Dwan-Ying Chang, I-Chun Chen, Ching-Hung Lin, Yen-Shen Lu
Organizations
National Taiwan University Hospital Hsinchu branch, Hsinchu City, Taiwan, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taipei, Taiwan, National Taiwan University Hospital, Taipei, Taiwan, National Taiwan University Cancer Center, Taipei, Taiwan
Abstract Disclosures
Research Funding
No funding received
None.
Background:
The concurrent use of doxorubicin and trastuzumab has been limited due to the increased risk of cardiac toxicity. Epirubicin is a less cardiotoxic alternative to doxorubicin, and the change in ejection fraction occurs until its cumulative dose doubles that with doxorubicin. This study aims to evaluate the cardiotoxicity and pathological complete response (pCR) rate associated with concurrent usage of epirubicin and trastuzumab in patients with HER2 positive early breast cancers (EBC).
Methods:
A literature search was conducted on NCBI/PubMed, and Cochrane database for phase II or III randomized controlled trials of concurrent use of epirubicin and trastuzumab in HER2 positive EBC between January 1, 2000 and February 28, 2021.The definition of adverse cardiac events varied among these trials, including changes in left ventricular systolic function and clinical heart failure. To compare the risk of cardiotoxicity and the odds of pCR rate between concurrent and non-concurrent regimens, a meta-regression analysis utilizing fixed-effects and mixed-effects linear models was conducted to investigate the relationship between various covariates.
Results:
Seven trials containing concurrent use of epirubicin and trastuzumab involving 1797 patients were analyzed. All of them are neoadjuvant studies. The median cumulative dose of epirubicin used was 300mg/m
2
and there were a total of 96 reported cardiac adverse events. The concurrent use of epirubicin and trastuzumab did not result in a statistically significant increase in cardiotoxicity compared to non-concurrent regimens (risk ratio = 1.18, 95% CI: 0.68-2.05). Meanwhile, there was a significant increase in pCR rate with the concurrent regimens (odds ratio = 1.48, 95% CI: 1.04-2.12). Mixed-effects meta-regression analysis showed that in trials with higher proportion of hormone receptor-positive EBC patients, the risk ratio of cardiotoxicity significantly increased with concurrent regimens and pathological complete response rate became less significant.
Conclusions:
The concurrent use of a limited dose of epirubicin and trastuzumab demonstrated a positive impact on pCR rate without a significant increase in cardiotoxicity. Further research is necessary to fully comprehend the long-term safety profile in individuals with metastatic breast cancer.
Characteristics of selected trials.
Study Name
Epirubicin cumulative dose (mg/m
2
)
Median Follow up (months)
Definition of ACE
Buzdar MDACC 2005
300
20
LVEF decrease >10%
CHER-LOB combo
300
6
LVSD >gr 1
GeparQuinto GBG 44
360
55
Gr1-4 congestive heart failure
TRYPHAENA seq
300
61
All grade LVSD
TRYPHAENA non-anthra
300
61
All grade LVSD
ACOSOG Z1041
300
5.52
LVSD
EORTC 10054
300
4.14
Absolute drop ≥ 15% in LVEF
from baseline
TRAIN-2
270
19
LVEF decline ≥10% AND LVEF < 50%
Abbreviations: ACE adverse cardiac event; LVEF left ventricular ejection fraction; LVSD left ventricular systolic dysfunction.
7 organizations
3 drugs
3 targets
Organization
Hsinchu CityOrganization
Taiwan Bio TherapeuticsOrganization
National Taiwan University College of MedicineOrganization
Taipei Medical University HospitalDrug
doxorubicinDrug
TrastuzumabDrug
epirubicinTarget
HER2 (ERBB2)Target
Topoisomerase IITarget
DNA topoisomerase II