Cardiac monitoring during adjuvant trastuzumab therapy. Guideline adherence in clinical practice

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1、ActaOncologica,2016;55:423429ORIGINALARTICLECardiacmonitoringduringadjuvanttrastuzumabtherapy:GuidelineadherenceinclinicalpracticeANNEMIEKVISSER1,ELINEM.W.VANDEVEN2,LARISSAI.A.RUCZYNSKI2,REINOUDJ.B.BLAISSE3,HENKK.VANHALTEREN4,KATJAABEN5,6&HANNEKEW.M.VANLAARHOVEN2,71DepartmentofMedicalPs

2、ychology,Radbouduniversitymedicalcenter,Nijmegen,TheNetherlands,2DepartmentofMedicalOncology,Radbouduniversitymedicalcenter,Nijmegen,TheNetherlands,3DepartmentofMedicalOncology,Rijnstate,Arnhem,TheNetherlands,4DepartmentofMedicalOncology,GelderseVallei,Ede,TheNetherlands,5ComprehensiveC

3、ancerCentreTheNetherlands,Utrecht,TheNetherlands,6DepartmentforHealthEvidence,Radbouduniversitymedicalcenter,Nijmegen,TheNetherlandsand7DepartmentofMedicalOncology,AcademicMedicalCenter,UniversityofAmsterdam,Amsterdam,TheNetherlandsABSTRACTBackground.Cardiotoxicityisanimportantadverseef

4、fectofadjuvantbreastcancertreatmentwithtrastuzumabandthreemonthlyleftventricularejectionfraction(LVEF)monitoringisconsideredmandatory.ThepurposeofthisstudywastogaininsightintoLVEFmonitoringduringadjuvanttrastuzumabtreatmentinclinicalpractice.Materialandmethods.Inamulticenterretrospectiv

5、estudyencompassing328patients,ofwhich171patientswereactuallytreatedwithtrastuzumab,weanalyzedthefrequencyandmodeofLVEFmonitoringandcompareditwithLVEFmonitoringguidelines.Results.Theresultsindicatedpoorguidelineadherence.In9%ofpatientstrastuzumabwasstartedinspiteofalowLVEF(55%).In24%ofp

6、atientsnovalidbaselineLVEFvaluewasavailable.LVEFmeasurementsduringtreatmentatthree,sixand12monthswereonlyperformedin,respectively,53%,40%and30%ofpatients.Conclusion.Asignificantproportionofpatientsaretreatedwithtrastuzumab,whileLVEFmonitoringisnotadequatelyperformed.Moreattentionshouldbe

7、paidtotheimplementationof(cardiacassessment)guidelinesinclinicalpractice.Inapproximately1525%ofbreasttumorstheHowever,trastuzumabtreatmentisalsoassoci-humanepidermalgrowthfactorreceptor2(HER2)atedwithsideeffects,mostpredominantlycardiacgeneisamplified,overexpressed,orboth,whichd