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

Prince Otchere; Olusola Adekoya; Samuel B Governor; Naveen Vuppuluri; Akruti Prabhakar; Stella Pak; Oduro Oppong-Nkrumah; Francis Cook; Rudy Bohinc; Gregory Aune

doi:10.1186/s40959-023-00177-y

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

Cardiooncology. 2023 May 19;9(1):26. doi: 10.1186/s40959-023-00177-y.

Authors

Affiliations

¹ The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
² Kettering Medical Center, Kettering, OH, USA.
³ Washington University School of Medicine, St. Louis, MO, USA.
⁴ Wright State University, Dayton, OH, USA.
⁵ Albany Medical Center, Albany, NY, USA. stellacpak@outlook.com.
⁶ McGill University, Montreal, QC, Canada.
⁷ Harvard University, Cambridge, MA, USA.

Abstract

Background: 25% 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.

Method: Using 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.

Results: The 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.

Conclusion: Cardiac 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.

Keywords: Breast Cancer; Cardiotoxicity; Predictive Model; Trastuzumab.