曲妥珠单抗辅助治疗期间的心脏监护：临床实践中的指南依从性

　　心脏毒性是曲妥珠单抗辅助治疗乳腺癌的重要副作用之一，每3个月进行左室射血分数（LVEF）监测被指南列为强制性措施。

　　2016年4月，北欧肿瘤学会官方期刊《肿瘤学报》（Acta Oncologica）将正式发表阿姆斯特丹大学、荷兰综合癌症中心、拉德堡德大学等机构的研究，对临床实践中曲妥珠单抗辅助治疗期间的LVEF监测进行了深入调查。

　　该多中心回顾研究包括328例患者，其中171例患者实际接受了曲妥珠单抗治疗，研究人员分析了LVEF监测的频次和方式，并与LVEF监测指南进行了比较。

　　结果表明指南依从性较差。9%的患者尽管LVEF低于55%，仍开始了曲妥珠单抗治疗。24%的患者无有效基线LVEF值可获得。仅有53%，40%和30%的患者在治疗期间3、6和12个月进行LVEF检测。

　　因此，虽然有相当比例的患者接受曲妥珠单抗治疗，但是仍未充分进行LVEF监测。在临床实践中，应该更加重视（心脏评估）指南的实施。

Acta Oncol. 2016 Apr;55(4):423-9.

Cardiac monitoring during adjuvant trastuzumab therapy: Guideline adherence in clinical practice.

Visser A, van de Ven EM, Ruczynski LI, Blaisse RJ, van Halteren HK, Aben K, van Laarhoven HW.

Radboud university medical center, Nijmegen, The Netherlands; Rijnstate, Arnhem, The Netherlands; Gelderse Vallei, Ede, The Netherlands; Comprehensive Cancer Centre The Netherlands, Utrecht, The Netherlands; Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

BACKGROUND: Cardiotoxicity is an important adverse effect of adjuvant breast cancer treatment with trastuzumab and three monthly left ventricular ejection fraction (LVEF) monitoring is considered mandatory. The purpose of this study was to gain insight into LVEF monitoring during adjuvant trastuzumab treatment in clinical practice.

MATERIAL AND METHODS: In a multicenter retrospective study encompassing 328 patients, of which 171 patients were actually treated with trastuzumab, we analyzed the frequency and mode of LVEF monitoring and compared it with LVEF monitoring guidelines.

RESULTS: The results indicated poor guideline adherence. In 9% of patients trastuzumab was started in spite of a low LVEF (< 55%). In 24% of patients no valid baseline LVEF value was available. LVEF measurements during treatment at three, six and 12 months were only performed in, respectively, 53%, 40% and 30% of patients.

CONCLUSION: A significant proportion of patients are treated with trastuzumab, while LVEF monitoring is not adequately performed. More attention should be paid to the implementation of (cardiac assessment) guidelines in clinical practice.

PMID: 26217988

DOI: 10.3109/0284186X.2015.1068444