The researchers conducted this study because older women who are at higher risk of decreased heart function, were often excluded from randomized clinical trials of trastuzumab, which is used to treat breast tumors that over-express human epidermal growth factor receptor-2 (HER-2). Past clinical trials in younger, healthier women showed improved survival, but also increased heart complications linked to trastuzumab, especially when combined with a frequently used therapy called anthracycline chemotherapy.
"We observed an even higher risk of heart failure or cardiomyopathy after trastuzumab therapy than those in past clinical trials," said lead author Jersey Chen, M.D., assistant professor of cardiology at Yale University School of Medicine and a member of the Yale Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center at Yale.
The Yale COPPER team examined the association between the use of adjuvant trastuzumab and anthracycline therapy and heart failure and cardiomyopathy, the most serious cardiotoxic complications, in 45,536 female Medicare beneficiaries with early-stage breast cancer. The use of trastuzumab has increased over time from 2.6% of the women who received any adjuvant therapy in 2000 to 22.6% in 2007.