Cardiotoxicity Associated with Trastuzumab Therapy in Taiwan: A Single Medical Center's 5-Year Experience

AbstractIntroductionTrastuzumab, a recombinant humanized monoclonal antibody, targets the external domain of HER2 to improve the efficacy of HER2-positive breast cancer treatment and inhibit carcinoma cellular proliferation. The purpose of this study was to identify early changes in cardiac function and dimensional changes in heart size in patients treated with trastuzumab.Materials and MethodsSeventy three female patients with Her2/neu overexpression (IHC 3+/Fish +) in breast cancer underwent echocardiography before and after trastuzumab therapy.ResultsCardiac complications developed in 14 patients (19.2%), including asymptomatic left ventricle systolic dysfunction (n = 12), symptomatic heart failure (n = 2), new asymptomatic left bundle branch block (n = 1), new negative T waves on electrocardiogram (n = 2), pericardial effusion (n = 1), and death (n = 1). No significant deterioration in diastolic function was noted, and right heart diameters and function did not change significantly. Most patients remained in an asymptomatic stage of cardiac disease. A significant decrease in left ventricular ejection fraction (LVEF) was observed in 14 patients (19.2%), and new mitral regurgitation (≥ grade 1) was noted after 3 months of trastuzumab therapy in 7 patients (9.6%).ConclusionsTrastuzumab led to measurable decreases in LVEF (but only 2.7% was symptomatic heart failure) and new mitral regurgitation. Therefore, regular follow-up with echocardiography is essential for early detection and prevention of trastuzumab-induced cardiomyopathy

Factors associated with alteration of nipple or skin sensation and impact of duration of time following nipple-sparing mastectomy (NSM): an analysis of 460 cases with comparison of conventional versus endoscopic- or robotic-assisted NSM

Abstract Background The current study aims to evaluate the nipple and skin sensation following nipple-sparing mastectomy (NSM) and identify patient-, surgical-, or treatment-related factors affecting nipple or skin sensation in this cohort. Methods Patients who received NSM with postoperative nipple and skin sensation test evaluation at a single institution over the past 10 years were retrospectively retrieved from a prospectively collected breast cancer surgery database. Results A total of 460 NSM procedures were included in this current study, with the mean age of 48.3 ± 9.1. Three-hundred eighty-three (83.3%) patients had breast reconstructions. One-hundred seventy-four (37.8%) received conventional NSM (C-NSM), 195 (42.4%) endoscopic-assisted NSM (E-NSM), and 91 (19.8%) robotic-assisted NSM (R-NSM) procedures. For nipple sensation assessment, 15 (3.3%) were grade 0, 83 (18.2%) grade I, 229 (49.7%) grade II, and 133 (28.9%) grade III (normal sensation), respectively, with mean grade score of 2.1 ± 0.7. The preserved (grade III) nipple sensation rate was 36.2% (63/174) in the C-NSM group, 26.7% (52/195) in the E-NSM group, and 19.7% (18/91) in the R-NSM group (P = 0.06). The “time since surgery to last evaluation” was significantly longer in the C-NSM group (45.6 ± 34 months) or E-NSM group (44.7 ± 35.8 months) as compared to R-NSM group (31.8 ± 16 months, P  60 months vs. ≦ 12 months: nipple odds ratio (OR) = 5.75, P < 0.01; skin, OR = 1.97, P < 0.05). Conclusion Our current analysis showed some factors to be related to postoperative nipple or skin sensation, and longer “time after surgery” was associated with significant improvement of nipple and skin sensation in patients who received NSM, regardless of the surgical approaches. Synopsis Our current analysis showed a significant portion of patients with decrease or loss of nipple or skin sensation after nipple-sparing mastectomy (NSM). Several factors associated with preserved nipple or skin sensation were identified, including age, surgical methods, surgical wound location, and association of time from surgery showing that improvement of partial nipple or skin sensation was evident after a longer follow-up