Development of cardiac risk prediction model in patients with HER-2 positive breast cancer on trastuzumab therapy

Cardio-Oncology

Research

Stella Pak¹  Francis Cook²  Rudy Bohinc³  Olusola Adekoya³  Naveen Vuppuluri³  Oduro Oppong-Nkrumah⁴  Prince Otchere⁵  Gregory Aune⁵  Samuel B. Governor⁶  Akruti Prabhakar⁷ 

[1] Albany Medical Center, Albany, NY, USA;Harvard University, Cambridge, MA, USA;Kettering Medical Center, Kettering, OH, USA;McGill University, Montreal, QC, Canada;The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA;Washington University School of Medicine, St. Louis, MO, USA;Wright State University, Dayton, OH, USA;

关键词: Predictive Model;    Cardiotoxicity;    Trastuzumab;    Breast Cancer;   

DOI  :  10.1186/s40959-023-00177-y

 received in 2022-11-02, accepted in 2023-05-12,  发布年份 2023

来源: Springer

【 摘 要 】

Background25% of all breast cancer patients have HER-2 overexpression. Breast Cancer patients with HER-2 overexpression are typically treated with HER-2 inhibitors such as Trastuzumab. Trastuzumab is known to cause a decrease in left ventricular ejection fraction. The aim of this study is to create a cardiac risk prediction tool among women with Her-2 positive breast cancer to predict cardiotoxicity.MethodUsing a split sample design, we created a risk prediction tool using patient level data from electronic medical records. The study included women 18 years of age and older diagnosed with HER-2 positive breast cancer who received Trastuzumab. Outcome measure was defined as a drop in LVEF by more than 10% to less than 53% at any time in the 1-year study period. Logistic regression was used to test predictors.ResultsThe cumulative incidence of cardiac dysfunction in our study was 9.4%. The sensitivity and specificity of the model are 46% and 84%, respectively. Given a cumulative incidence of cardiotoxicity of 9%, the negative predictive value of the test was 94%. This suggests that in a low-risk population, the interval of screening for cardiotoxicity may be performed less frequently.ConclusionCardiac risk prediction tool can be used to identify Her-2 positive breast cancer patients at risk of developing cardiac dysfunction. Also, test characteristics in addition to disease prevalence may inform a rational strategy in performing cardiac ultrasound in Her-2 breast cancer patients. We have developed a cardiac risk prediction model with high NPV in a low-risk population which has an appealing cost-effectiveness profile.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

Fig. 8