• C Serrano, J Cortés, L De Mattos-Arruda, M Bellet, P Gómez, C Saura, J Pérez, M Vidal, E Muñoz-Couselo, M J Carreras, G Sánchez-Ollé, J Tabernero, J Baselga, and S Di Cosimo.
• Breast Cancer Center, Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona, Spain. ceserran@vhebron.net
• Ann. Oncol. 2012 Apr 1; 23 (4): 897-902.

BackgroundElderly breast cancer patients are usually excluded from clinical trials. Nevertheless, with the increasing use of trastuzumab, there is a need to address trastuzumab-related cardiotoxicity in this population.Patients And MethodsRecords for patients ≥ 70 years treated with trastuzumab since 2005 were reviewed. New York Heart Association classification was used to document symptomatic cardiotoxicity. Asymptomatic cardiotoxicity was defined as an absolute drop ≥ 10% with a final left ventricular ejection fraction < 50% or an absolute drop > 20%.ResultsForty-five patients, median age 75.9 years (range 70-92), were identified. Three of 24 (12.5%) early breast cancer patients and 5 of 21 (23.8%) with advanced disease experienced asymptomatic cardiotoxicity. Four of 45 patients (8.9%), all with advanced breast cancer, developed symptomatic congestive heart failure. All but one of them recovered in a median time of 5 weeks (range 3-21). Patients with trastuzumab-related cardiotoxicity presented more often with cardiovascular risk factors, such as history of cardiac disease (33% versus 9.1%, P = 0.017) and diabetes (33.3% versus 6.1%, P = 0.010), compared with those without.ConclusionsElderly breast cancer patients with a history of cardiac disease and/or diabetes treated with trastuzumab have an increased incidence of cardiotoxicity. Continuous cardiac monitoring is especially advised in this population.

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