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| |  Bevacizumab Cardiotoxic in Breast Cancer Patients Treated With Anthracyclines and Trastuzumab: Presented at ASCO By Cameron Johnston CHICAGO -- June 7, 2010 -- Bevacizumab can be cardiotoxic when used on its own, and it might very well compound the problem when patients are using concomitant anthracyclines or concomitant/previous trastuzumab, researchers noted here at the 2010 Annual Meeting of the American Society of Clinical Oncology (ASCO). In some patients, the cardiotoxic impact of bevacizumab will cause them to discontinue therapy. In the study, 164 women who had had neoadjuvant chemotherapy to treat stage II or III breast cancer and had residual, invasive disease, were enrolled in 4 sequential cohorts and were treated with one of the following: bevacizumab alone; bevacizumab together with methotrexate and cyclophosphamide; or 2 different doses of capecitabine together with bevacizumab. The most severe cardiac events occurred in women who had had prior anthracycline and trastuzumab exposure, although more risk factors have yet to be described. It is well known that drugs such as anthracyclines and trastuzumab are both cardiotoxic for some cancer patients. Less well known is the cardiotoxic impact of giving bevacizumab to patients who have been pretreated with either of the other 2 agents. Patients underwent full cardiac analysis at baseline -- including left ventricular ejection fraction (LVEF) – and then were monitored at 6 months, 1 year, and finally, 1 year after stopping bevacizumab therapy, explained lead author Erica Mayer, MD, MPH, Breast Oncology Center, Dana-Farber Cancer Institute, Boston, Massachusetts, speaking here on June 5. Ninety-five percent of the women had undergone prior anthracycline exposure and 8% were using concurrent trastuzumab. At 6 months follow-up, 9% of women (n = 12) had a drop in LVEF of 10% to 14%. Two women had a reduction of 15% or greater. One year after ending bevacizumab treatment, LVEF rates had returned to baseline or near baseline levels for all but 3 of the women whose decrease was 10% to 14%. Neither of the women whose LVEF decreased by 15% or more returned to baseline. The change in cardiac function led 4 women to discontinue treatment. Two of the women had asymptomatic grade II LVEF detected at the 6-month visit. One of these women was receiving bevacizumab plus metronomic therapy and 1 was receiving bevacizumab plus capecitabine. Two women also developed symptomatic grade III to IV LVEF after 4 and 11 months respectively. The patient whose symptoms occurred at 4 months recovered normal cardiac function when therapy was stopped and other cardiac medications were ordered. The other patient died of progressive congestive heart failure. Three patients also stopped therapy due to the onset of grade 3 hypertension. Overall, the authors concluded that adjuvant bevacizumab might be associated with cardiovascular toxicity, including the onset of hypertension, changes in LVEF that are usually modest, and rarely, congestive heart failure. The authors concluded that careful management of bevacizumab-related cardiotoxicity, including hypertension, might be warranted to avoid more severe cardiac sequelae. [Presentation title: Cardiovascular Safety of Adjuvant Bevacizumab for Breast Cancer. Abstract 571]
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