Impact of adjuvant trastuzumab therapy and its discontinuation on cardiac function and mortality in patients with early-stage breast cancer: An analysis based on the Japanese Receipt Claim Database
Standard trastuzumab therapy can reduce the risk of early recurrence of HER2-positive breast cancer. However, trastuzumab-induced cardiac dysfunction may force the discontinuation of adjuvant trastuzumab therapy. Incidentally, there are still unclear whether or not trastuzumab treatment should be co...
Saved in:
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-02-01
|
| Series: | Breast |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0960977624002029 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1823856882576523264 |
|---|---|
| author | Keiko Miyazato Hiroshi Ohtsu Akihiko Shimomura Naohiro Yonemoto Chikako Shimizu Kazuhiro Sase Shinichiro Ueda |
| author_facet | Keiko Miyazato Hiroshi Ohtsu Akihiko Shimomura Naohiro Yonemoto Chikako Shimizu Kazuhiro Sase Shinichiro Ueda |
| author_sort | Keiko Miyazato |
| collection | DOAJ |
| description | Standard trastuzumab therapy can reduce the risk of early recurrence of HER2-positive breast cancer. However, trastuzumab-induced cardiac dysfunction may force the discontinuation of adjuvant trastuzumab therapy. Incidentally, there are still unclear whether or not trastuzumab treatment should be continued in the setting of reduced cardiac function. We aimed to investigate the association between trastuzumab discontinuation, the development of cardiac dysfunction during trastuzumab treatment, and all-cause mortality using the JMDC as the Japanese claims database. Between 2010 and 2019, 1779 women with early-stage breast cancer underwent surgery with adjuvant trastuzumab therapy (TZ). A 1:1 propensity score (PS) matching was conducted for patients who completed or discontinued TZ. The rates of cancer therapy-related-cardiovascular toxicity (CTR-CVT) and mortality in the TZ completion and discontinuation groups were compared. After PS matching, the TZ completion group (CMP_PSM: n = 83) and discontinuation group (INT_PSM: n = 83) were included in the study. TZ was administered for 12 and 5 months in CMP_PSM and INT_PSM, respectively. The cumulative incidence of CTR-CVT was significantly higher in CMP_PSM than INT_PSM (log-rank test, P = .0096). The mortality rate was significantly higher in INT_PSM than in CMP_PSM. The all-cause mortality in INT_PSM tended to increase at a constant rate after treatment, even after discontinuation. Our findings suggest that discontinuation of trastuzumab treatment worsens patient prognosis due to insufficient treatment of breast cancer rather than due to the cardiovascular toxicity of the drug. |
| format | Article |
| id | doaj-art-16eb3eb39136438bbde5ed65a4345448 |
| institution | Kabale University |
| issn | 1532-3080 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Breast |
| spelling | doaj-art-16eb3eb39136438bbde5ed65a43454482025-02-12T05:30:38ZengElsevierBreast1532-30802025-02-0179103871Impact of adjuvant trastuzumab therapy and its discontinuation on cardiac function and mortality in patients with early-stage breast cancer: An analysis based on the Japanese Receipt Claim DatabaseKeiko Miyazato0Hiroshi Ohtsu1Akihiko Shimomura2Naohiro Yonemoto3Chikako Shimizu4Kazuhiro Sase5Shinichiro Ueda6Department of Clinical Research and Management, Graduate School of Medicine, University of Ryukyus, Japan; Department of Breast Surgery, Urasoe General Hospital, JapanFaculty of Health Data Science, Juntendo University, Japan; Clinical Pharmacology and Regulatory Science, Graduate School of Medicine, Juntendo University, Japan; Institute for Medical Regulatory Science, Organization for University Research Initiatives, Waseda University, JapanDepartment of Breast and Medical Oncology, National Center for Global Health and Medicine, JapanDepartment of Public Health, Graduate School of Medicine, Juntendo University, Japan; Department of Biostatistics, Faculty of Medicine, University of Toyama, JapanDepartment of Breast and Medical Oncology, National Center for Global Health and Medicine, JapanClinical Pharmacology and Regulatory Science, Graduate School of Medicine, Juntendo University, Japan; Institute for Medical Regulatory Science, Organization for University Research Initiatives, Waseda University, JapanDepartment of Clinical Research and Management, Graduate School of Medicine, University of Ryukyus, Japan; Department of Clinical Pharmacology, Faculty of Medicine, University of the Ryukyus, Japan; Corresponding author. 207 Uehara, Nishihara-cho, Okinawa, 903-0215, Japan.Standard trastuzumab therapy can reduce the risk of early recurrence of HER2-positive breast cancer. However, trastuzumab-induced cardiac dysfunction may force the discontinuation of adjuvant trastuzumab therapy. Incidentally, there are still unclear whether or not trastuzumab treatment should be continued in the setting of reduced cardiac function. We aimed to investigate the association between trastuzumab discontinuation, the development of cardiac dysfunction during trastuzumab treatment, and all-cause mortality using the JMDC as the Japanese claims database. Between 2010 and 2019, 1779 women with early-stage breast cancer underwent surgery with adjuvant trastuzumab therapy (TZ). A 1:1 propensity score (PS) matching was conducted for patients who completed or discontinued TZ. The rates of cancer therapy-related-cardiovascular toxicity (CTR-CVT) and mortality in the TZ completion and discontinuation groups were compared. After PS matching, the TZ completion group (CMP_PSM: n = 83) and discontinuation group (INT_PSM: n = 83) were included in the study. TZ was administered for 12 and 5 months in CMP_PSM and INT_PSM, respectively. The cumulative incidence of CTR-CVT was significantly higher in CMP_PSM than INT_PSM (log-rank test, P = .0096). The mortality rate was significantly higher in INT_PSM than in CMP_PSM. The all-cause mortality in INT_PSM tended to increase at a constant rate after treatment, even after discontinuation. Our findings suggest that discontinuation of trastuzumab treatment worsens patient prognosis due to insufficient treatment of breast cancer rather than due to the cardiovascular toxicity of the drug.http://www.sciencedirect.com/science/article/pii/S0960977624002029Breast neoplasmTrastuzumabHeart diseasePropensity scoreJapanMortality |
| spellingShingle | Keiko Miyazato Hiroshi Ohtsu Akihiko Shimomura Naohiro Yonemoto Chikako Shimizu Kazuhiro Sase Shinichiro Ueda Impact of adjuvant trastuzumab therapy and its discontinuation on cardiac function and mortality in patients with early-stage breast cancer: An analysis based on the Japanese Receipt Claim Database Breast Breast neoplasm Trastuzumab Heart disease Propensity score Japan Mortality |
| title | Impact of adjuvant trastuzumab therapy and its discontinuation on cardiac function and mortality in patients with early-stage breast cancer: An analysis based on the Japanese Receipt Claim Database |
| title_full | Impact of adjuvant trastuzumab therapy and its discontinuation on cardiac function and mortality in patients with early-stage breast cancer: An analysis based on the Japanese Receipt Claim Database |
| title_fullStr | Impact of adjuvant trastuzumab therapy and its discontinuation on cardiac function and mortality in patients with early-stage breast cancer: An analysis based on the Japanese Receipt Claim Database |
| title_full_unstemmed | Impact of adjuvant trastuzumab therapy and its discontinuation on cardiac function and mortality in patients with early-stage breast cancer: An analysis based on the Japanese Receipt Claim Database |
| title_short | Impact of adjuvant trastuzumab therapy and its discontinuation on cardiac function and mortality in patients with early-stage breast cancer: An analysis based on the Japanese Receipt Claim Database |
| title_sort | impact of adjuvant trastuzumab therapy and its discontinuation on cardiac function and mortality in patients with early stage breast cancer an analysis based on the japanese receipt claim database |
| topic | Breast neoplasm Trastuzumab Heart disease Propensity score Japan Mortality |
| url | http://www.sciencedirect.com/science/article/pii/S0960977624002029 |
| work_keys_str_mv | AT keikomiyazato impactofadjuvanttrastuzumabtherapyanditsdiscontinuationoncardiacfunctionandmortalityinpatientswithearlystagebreastcancerananalysisbasedonthejapanesereceiptclaimdatabase AT hiroshiohtsu impactofadjuvanttrastuzumabtherapyanditsdiscontinuationoncardiacfunctionandmortalityinpatientswithearlystagebreastcancerananalysisbasedonthejapanesereceiptclaimdatabase AT akihikoshimomura impactofadjuvanttrastuzumabtherapyanditsdiscontinuationoncardiacfunctionandmortalityinpatientswithearlystagebreastcancerananalysisbasedonthejapanesereceiptclaimdatabase AT naohiroyonemoto impactofadjuvanttrastuzumabtherapyanditsdiscontinuationoncardiacfunctionandmortalityinpatientswithearlystagebreastcancerananalysisbasedonthejapanesereceiptclaimdatabase AT chikakoshimizu impactofadjuvanttrastuzumabtherapyanditsdiscontinuationoncardiacfunctionandmortalityinpatientswithearlystagebreastcancerananalysisbasedonthejapanesereceiptclaimdatabase AT kazuhirosase impactofadjuvanttrastuzumabtherapyanditsdiscontinuationoncardiacfunctionandmortalityinpatientswithearlystagebreastcancerananalysisbasedonthejapanesereceiptclaimdatabase AT shinichiroueda impactofadjuvanttrastuzumabtherapyanditsdiscontinuationoncardiacfunctionandmortalityinpatientswithearlystagebreastcancerananalysisbasedonthejapanesereceiptclaimdatabase |