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| |  Risk of LVF Decline in Breast Cancer Patients Decreases With Left-Side Irradiation, Combination Therapy: Presented at ASTRO By John Otrompke CHICAGO -- November 9, 2009 -- Use of combination therapy to treat human epidermal growth factor receptor 2 (HER2)-positive breast cancer is not associated with a decline in left ventricular function (LVF), nor is left-side irradiation, researchers stated here at the American Society of Therapeutic Radiology and Oncology (ASTRO) 51st Annual Meeting. While both trastuzumab and radiation are associated with reduced LVF, the combination of the 2 is not associated with any increased injury, according to Michele Halyard, MD, Mayo Clinic, Scottsdale, Arizona, “When you study eradiation patients long enough, you find that the pumping function can decline as well,” said Dr. Halyard on November 3. “So we need to do further follow-up for this study, because with radiation therapy, patients often don’t see the cardiac toxicity for 10 to 15 years.” The study looked at 3,505 women with HER2-positive breast cancer who were randomised to received doxorubicin, paclitaxel, and cyclophosphamide, with or without trastuzumab. The patients received lumpectomy or mastectomy followed by radiation therapy within 5 weeks thereafter. The researchers looked at 576 patients who completed treatment, 311 who received right-side radiation therapy, and 265 who received left-side radiation therapy. LVF was examined 2 to 4 months after the start of radiation therapy, and compared with LVF 4 weeks prior to the start of radiation therapy. “When we treat patients with cancer in the left breast with radiation therapy, in some patients we get part of the heart within the radiation field, but patients treated on the right side don’t get any part of their heart in the field,” Dr. Halyard explained. At 2 to 4 months following radiation therapy, in the arm treated initially with trastuzumab, 23% of patients with left-side radiation experienced more than a 5% decline in LVF, compared with 25% of those treated with right-side radiation. Of the arms treated initially with trastuzumab, 27% of those with left-side radiation experienced more than a 5% decline in LVF, compared with 36% of those with right-side radiation, while 22% of those with left-side radiation experienced at least 5% decline, compared with 25% of those who underwent right-side irradiation. [Presentation title: Changes in Left Ventricular Function After Radiation Therapy and Trastuzumab: Analysis of North Central Cancer Treatment Group Phase III Trial N9831. Abstract 106]
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