佐劑曲妥珠單抗（赫賽汀）是人表皮生長(cháng)因子受體2陽(yáng)性的早期乳腺癌(HER2+EBC)化療的金標準。年紀大的乳腺癌患者（60歲以上）因病例數目不足一直缺乏臨床實(shí)驗證據，因此尚沒(méi)有研究數據顯示該人群中的曲妥珠單抗（赫賽汀）的心臟毒性。

    發(fā)表在A(yíng)nnals Oncology雜志上的一篇文章對老齡乳腺癌患者使用曲妥珠單抗（赫賽汀）的心臟毒性進(jìn)行了研究。499名HER2+乳腺癌患者在意大利的10家醫療機構連續接受佐劑曲妥珠單抗（赫賽汀）的化療。研究人員評估了60歲以上患者使用赫賽汀后發(fā)生心臟毒性風(fēng)險的機率。

    結果顯示，160名（32%）60歲以上的患者中，表現出較高發(fā)生的高血壓、糖尿病、腎功能不全和血脂異常。60歲以上的患者中，有6%發(fā)生心衰，而年輕組的患者只有2%。33%的60歲以上患者組左室射血分數受到影響，而在年輕組，只有23%受影響。

    在該項臨床實(shí)驗中，32%的使用曲妥珠單抗（赫賽汀）化療的人表皮生長(cháng)因子受體2陽(yáng)性的早期乳腺癌(HER2+EBC)患者年齡在60歲以上，這些病人表現為增高的心臟風(fēng)險，一般發(fā)展為佐劑曲妥珠單抗（赫賽汀）心臟毒性損害。

    Adjuvant trastuzumab cardiotoxicity in patients over 60 years of age with early breast cancer: a multicenter cohort analysis

    Background: Adjuvant Trastuzumab with chemotherapy is the gold standard for human epidermal growth factor receptor 2 (HER2)-positive early breast cancer (HER2+ EBC). Older patients have been largely under-represented in clinical trials, and few data on Trastuzumab cardiotoxicity have been reported in this subgroup.

    Patients and methods: Four hundred and ninety-nine consecutive HER2+ EBC patients were treated with adjuvant trastuzumab and chemotherapy (aTrastC) at 10 Italian institutions. We evaluated disease prevalence and patient characteristics in the patients older than 60 years of age (over-60), prevalence of aTrastC cardiotoxicity and risk factors.

    Results: There were 160 ‘over-60’ patients (32%), in whom a higher prevalence of hypertension, diabetes, renal dysfunction, dyslipidemia and treatment with ACEi (40 versus 8%) and beta blockers (20 versus 8%) was found than in the younger patients (339 = 68%). Clinical heart failure occurred in 6% of the ‘over-60’ and in 2% of the younger patients. A reduction in left ventricular ejection fraction of >10 points was detected in 33% of the ‘over-60’ and in 23% of the younger patients (all P < 0.05). aTrastC was discontinued in 10% of the ‘over-60’ and in 4% of the younger patients (P = 0.003), restarted in 44% of the ‘over-60’ and in 58% of the younger women (P = ns).

    Conclusion: In clinical practice, 32% of HER2+ EBC patients treated with aTrastC are ‘over-60’. These patients have an increased cardiovascular risk profile and develop aTrastC cardiotoxicity commonly.