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Managing Cardiac AEs in HER2-Positive Breast Cancer

Angelica Welch
Published: Friday, Mar 16, 2018

Jean-Bernard Durand, MD
Jean-Bernard Durand, MD
Certain treatments for patients with HER2-positive breast cancer can increase the risk of cardiovascular events or injury, but there are strategies for protecting patients’ hearts from anthracyclines and HER2-targeted therapies, Jean-Bernard Durand, MD, said in a presentation during the 2018 Annual Miami Breast Cancer Conference.

One of the simpler preventative measures Durand implored community oncologists to do is encourage their patients to continue with an exercise routine during cancer treatment as it strengthens the heart. More importantly though, he says, is recognizing the symptoms as soon as possible by conducting a complete medical exam and history during the first appointment with a new patient.

In a second presentation, Durand discussed the possibility of repairing cardiac damage in patients with HER2-positive breast cancer. He assured that with proper management of comorbidities, as well as using a multidisciplinary approach, extending the survival of these patients is possible.

In an interview with OncLive during the meeting, Durand, a professor in the Department of Cardiology at The University of Texas MD Anderson Cancer Center, discussed prevention, recognition, and treatment of patients with HER2-positive breast cancer who experience cardiac-related events prior to or during treatment.

OncLive: What are the main points of your presentation on protecting patients' hearts from anthracyclines and HER2-targeted therapies?

Durand: The take-home message is the importance of continuing HER2/neu therapy with minimal to zero toxicities. There has not been a lot of clinical data on how we can prevent toxicities from occurring. We have learned that routine heart failure therapies, such as ACE inhibitors and beta blockers, may have some protective role that could allow a patient to complete therapy without cardiovascular adverse events (AEs). Other things that we learned are the importance of giving a continuous infusion of doxorubicin, rather than giving a bolus infusion, in the amount of time that a patient is free of treatment. In other words, when anthracycline-based therapies are followed by HER2/neu therapies within 30 days, the incidence of injury to the heart is much higher than waiting 60 to 90 days.

Is there a way to predict whether a certain patient is going to experience these toxicities?

We know that 25% of these patients will express HER2 in the heart. Of the individuals who do express it, we know that they may have a predisposition to develop some sort of entry to the heart, which we now know is reversible. There may be predispositions, such as the presence of hypertension that is not adequately treated, diabetes that is not aggressively treated, a previous heart attack or any structural heart disease. If we can treat these prior to starting HER2/neu therapy, we can lower the incidence of toxicities. These are simple everyday measures that we can do.


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