Cardiotoxic Effects of HER2-Targeted Therapies: Insights From a Retrospective Study at a Romanian Oncology Center

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BACKGROUND: Cardiotoxicity remains a significant concern for patients undergoing HER2-targeted therapies for HER2-positive breast cancer. While trastuzumab and pertuzumab have dramatically improved survival outcomes, their impact on cardiovascular health underscores the need for comprehensive risk assessment and preventive strategies. Methods: This retrospective study evaluates the incidence and risk factors associated with cardiotoxicity in 45 female patients treated with trastuzumab and/or pertuzumab at the Institute of Oncology Bucharest from 2018 to 2022. Data on demographics, comorbidities, treatment regimens, and cardiac function were collected. Cardiotoxicity was defined as a >10% decline in left ventricular ejection fraction (LVEF) or symptomatic heart failure. Statistical analyses, including chi-square tests, t-tests, and logistic regression, were used to explore associations between risk factors and cardiotoxicity. Results: The mean age of participants was 58 years, with 15 (33%) aged ≥65 years. Comorbidities included hypertension in 14 patients (31%), diabetes in seven patients (16%), and prior cardiac issues in five patients (11%). Cardiotoxicity was observed in 12 patients (27%), with five patients (11%) progressing to symptomatic heart failure. Older age (p = 0.022), higher BMI (p = 0.012), and hypertension (p = 0.016) were significantly associated with increased cardiotoxicity risk, while anthracycline exposure showed no significant association (p = 0.324). Multivariate logistic regression identified BMI as the only independent predictor (p = 0.007). Conclusion: HER2-targeted therapies pose a considerable cardiotoxicity risk, particularly in patients with older age, hypertension, and higher BMI. Early identification of at-risk patients through comprehensive cardiac risk assessments, advanced imaging techniques, and the use of cardioprotective medications is essential for minimizing complications. Further research into biomarkers and newer HER2-targeted agents with lower cardiotoxicity profiles may improve therapeutic outcomes while preserving cardiac health.

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