Neoplasms

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Symptoms and General Pathology

Breast Neoplasms

Systolic Murmurs

Breast Diseases

Skin Diseases

Antineoplastic Agents

All Drugs and Chemicals

Anti-Arrhythmia Agents

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Analgesics

Trastuzumab

Adrenergic beta-Antagonists

Pertuzumab

Ado-Trastuzumab Emtansine

Angiotensin-Converting Enzyme Inhibitors

Adenosine

Maytansine

Antineoplastic Agents, Immunological

Tubulin Modulators

Antimitotic Agents

Immunotoxins

Immunoconjugates

Immunologic Factors

Cardiac intervention - beta-blockers and ACE-inhibitors titrated to the maximum tolerated doses

Oncology intervention - patients will receive one of the three following HER2 targeted therapies at the discretion of the treating oncologist:

* Trastuzumab: loading dose of 8 mg/kg IV, followed by a maintenance dose of 6 mg/kg every 3 weeks, or a loading dose of 4 mg/kg followed by a maintenance dose of 2 mg/kg every week.
* Pertuzumab: loading dose of 840 mg IV, followed by 420 mg IV every 3 weeks, administered concomitantly with trastuzumab.
* Ado trastuzumab emtansine (TDM1): 3.6mg/kg IV every three weeks.

Ado Trastuzumab Emtansine

Sandra M Swain, MD

HER2 positive breast cancer cells have more HER2 receptor (a protein on the surface of cells) than normal breast cells. Approximately 30% of patients with breast cancer have HER2 positive breast cancer. Before HER2 targeted therapies (i.e. treatments that directly block the receptor HER2) were developed, patients with HER2 positive breast cancer had a very aggressive form of disease. With the use of trastuzumab, an anticancer drug that directly targets the receptor HER2, and more recently, pertuzumab and ado-trastuzumab emtansine, patients are able to live longer and have better control of their cancer.

Unfortunately the use of HER2 targeted therapies can increase the risk of heart problems and for this reason these treatments were only studied and approved for patients with normal heart function.

In this study we plan to give HER2 targeted therapies to patients with HER2 positive breast cancer and mildly decreased heart function along with concomitant evaluation by a heart doctor (called cardiologist) and appropriate medications to strengthen the heart. We will do frequent monitoring of the heart function with a test called echocardiogram that will give us a detailed "picture" of the heart. We will also draw blood along with routine blood tests to try to understand why some patients develop heart problems and others do not. The study will take a maximum of 12 months and patients will be monitored for 6 additional months.

We hypothesize that it is safe to administer HER2 targeted therapies to patients with breast cancer and mildly decreased heart function, i.e. LVEF between 40 and 50%, while on appropriate heart medications.

Title: A pilot study evaluating the cardiac safety of HER2 targeted therapy (non-lapatinib) in patients with HER2 positive breast cancer and reduced left ventricular function Phase: Pilot study Study Duration: 4 years with up to 5 additional years of follow up Study Center(s): 3 centers will be participating: MedStar Washington Hospital Center (MWHC), MedStar Georgetown University Hospital (MGUH) and Memorial Sloan Kettering Cancer Center (MSKCC) Primary Objective: To evaluate the cardiac safety of HER2 targeted therapy (non-lapatinib) in patients with HER2 positive breast cancer and reduced left ventricular ejection fraction (LVEF) when given concomitantly with cardiac treatment.

Secondary Objectives:

* To evaluate time to development of cardiac event or asymptomatic worsening of cardiac function
* Absolute changes in LVEF
* Delays in HER2 therapy attributed to cardiac causes
* Correlations between echocardiographic myocardial strain
* cTnI and hs-cTnT at baseline and over time with cardiac events and asymptomatic worsening of cardiac function Sample size: 30 patients

Diagnosis and Main Inclusion Criteria:

* HER2 positive breast cancer, stage I-IV.
* Mildly decreased cardiac function (LVEF between 40 and 49%) prior to or while receiving non-lapatinib HER2 targeted therapy

Cardiac Intervention:

- Beta-blockers and ACE-inhibitors titrated to the maximum tolerated doses

Oncology study Products, Doses, Routes, Regimens:

* Trastuzumab: loading dose of 8 mg/kg IV, followed by a maintenance dose of 6 mg/kg every 3 weeks, or a loading dose of 4 mg/kg followed by a maintenance dose of 2 mg/kg every week.
* Pertuzumab: loading dose of 840 mg IV, followed by 420 mg IV every 3 weeks, administered concomitantly with trastuzumab.
* Ado-trastuzumab emtansine: 3.6mg/kg IV every three weeks. Note: both trastuzumab and pertuzumab may be administered alone or in combination with other systemic or radiation therapy.

Duration of drug administration: Maximum of 12 months.

Cardiac Safety Study in Patients With HER2 + Breast Cancer

SAFE-HEaRt: A Pilot Study Assessing the Cardiac SAFEty of HER2 Targeted Therapy in Patients With HER2 Positive Breast Cancer and Reduced Left Ventricular Function

Cardiac events are defined as any of the following:

* Presence of symptoms attributable to heart failure as confirmed by a cardiologist
* Cardiac arrhythmia requiring pharmacological or electrical treatment
* Myocardial infarction
* Sudden cardiac death or death due to myocardial infarct, arrhythmia or heart failure

Asymptomatic worsening of cardiac function defined as:

- Asymptomatic decline in LVEF \> 10% points from baseline and/or EF \< 35% corroborated by a confirmatory echocardiogram in 2-4 weeks

Planned oncologic therapy is defined as:

* In the adjuvant setting: completion of 1 year total of HER2 targeted therapy. If a patient already received part of the planned HER2 targeted therapy prior to enrollment in this trial, planned oncologic therapy will be achieved when a total of 1 year is completed.
* In the metastatic setting: cessation of treating regimen due to progressive disease or non-cardiac toxicity or non-cardiac death.

Difference in LVEF between end of treatment and baseline

Proportion of patients that had a hold because of symptomatic or asymptomatic cardiotoxicity.

Hold is defined as any delay or discontinuation of HER2 targeted therapy due to cardiac toxicity. One cycle of HER2 targeted therapy will be considered 3 weeks. One therapy hold will be defined as any 3-week HER2 targeted therapy missed dose or 1/3 if one weekly trastuzumab dose. For patients who had a hold and resumed HER2 targeted therapy, duration of treatment hold will be described.

Genentech, Inc.

Medstar Health Research Institute

Cardiac intervention - beta-blockers and ACE-inhibitors titrated to the maximum tolerated doses

Oncology intervention - patients will receive one of the three following HER2 targeted therapies at the discretion of the treating oncologist:

* Trastuzumab: loading dose of 8 mg/kg IV, followed by a maintenance dose of 6 mg/kg every 3 weeks, or a loading dose of 4 mg/kg followed by a maintenance dose of 2 mg/kg every week.
* Pertuzumab: loading dose of 840 mg IV, followed by 420 mg IV every 3 weeks, administered concomitantly with trastuzumab.
* Ado trastuzumab emtansine (TDM1): 3.6mg/kg IV every three weeks.

Trastuzumab: HER2 therapy

Pertuzumab: HER2 therapy

Ado Trastuzumab Emtansine: HER2 therapy

HER2 Therapies, Cardiac Medications

Age, Categorical

Age, Continuous

Sex: Female, Male

Non-Latino Black

Non-Latino White

Hispanic

Race/Ethnicity, Customized

United States

Region of Enrollment

Allison Moses

Percentage of Patients Who Complete Planned Oncologic Therapy Without the Development of a Cardiac Event or Asymptomatic Worsening of Cardiac Function.

Median Time to Development of an Event Defined as Cardiac Event or Asymptomatic Worsening of Left Ventricular Dysfunction, Among Patients Who Developed One Event.

Absolute Changes in LVEF During HER2 Targeted Therapy Between Baseline and End of Treatment

HER2 Therapy Holds Attributed to Proportion of Patients With Symptomatic or Asymptomatic Cardiotoxicity.

There were too few clinical events to assess correlations

Correlation of Global Longitudinal Myocardial Strain With Cardiac Events and Asymptomatic Worsening of Cardiac Function

This outcome was not analyzed. There were too few clinical events to assess correlations.

Correlation of Standard Cardiac Troponin I and Highly Sensitive Cardiac Troponin T With Cardiac Events and Asymptomatic Worsening of Cardiac Function

Overall Study

Heart and Blood Diseases

Substance Related Disorders

Wounds and Injuries

Cardiotoxicity

Heart Diseases

Drug-Related Side Effects and Adverse Reactions

Chemically-Induced Disorders

Radiation Injuries

Hyung-Kwan Kim, M.D., PhD

Trastuzumab prolongs survival in patients with human epidermal growth factor receptor type 2-positive breast cancer. Sequential left ventricular (LV) ejection fraction (EF) assessment has been mandated to detect myocardial dysfunction because of the risk of heart failure with this treatment. Myocardial deformation imaging is a sensitive means of detecting LV dysfunction, but this technique has not been evaluated in patients treated with trastuzumab. The aim of this study was to investigate whether changes in tissue deformation, assessed by myocardial strain and strain rate (SR), are able to identify LV dysfunction earlier than conventional echocardiographic measures in patients treated with trastuzumab.

The investigators will prospectively evaluate whether changes in tissue deformation, assessed by myocardial strain and strain rate (SR) and identify possibility of early detection of LV dysfunction in patients treated with trastuzumab.

genetic susceptibility for HER2(+)cardiotoxicity

Usefulness of Myocardial Deformation Imaging for Trastuzumab-induced Cardiotoxicity

Usefulness of Myocardial Deformation Imaging in Breast Cancer Patients Treated With Trastuzumab for Early Detection of Myocardial Dysfunction

LV systolic dysfunction was defined as following;

1. An EF unit drop of ≥10% from the baseline available echocardiogram or
2. Change in strain or strain rate : drop(decrement) corresponding to ≥1 SD of the relevant parameter assessed at the baseline available echocardiogram

Seoul National University Hospital

MD, PhD, Assistant Professor, Seoul National University Cardiovascular center

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Cardiac Safety Study in Patients With HER2 + Breast Cancer	NCT01904903	HER2 Positive B... Left Ventricula...	Trastuzumab Pertuzumab Ado Trastuzumab...	18 Years - 120 Years	Medstar Health Research Institute
Usefulness of Myocardial Deformation Imaging for Trastuzumab-induced Cardiotoxicity	NCT01665300	Left Ventricula... Cardiotoxicity		18 Years - 75 Years	Seoul National University Hospital
Cardiac Safety Study in Patients With HER2 + Breast Cancer	NCT01904903	HER2 Positive B... Left Ventricula...	Trastuzumab Pertuzumab Ado Trastuzumab...	18 Years - 120 Years	Medstar Health Research Institute

Spots Global Cancer Trial Database for left ventricular function systolic dysfunction