Letter to the Editor Simultaneous hemodynamic and serological cardiotoxicity monitoring during immunotherapy with trastuzumab

Background: Immunotherapy with trastuzumab (Herceptin), a selective HER-2(ErbB2)-antibody, is associated with a certain degree of cardiotoxicity. This study sought to evaluate the immediate hemodynamic response to trastuzumab with real-time CW-Doppler depending on the level of nt-pro-BNP (brain natriuretic peptide) as a possible marker of cardiotoxicity. Methods: 48 patients with HER-2-positive metastatic breast cancer were continuously measured with CW-Doppler ultrasound for cardiac output (CO) and systemic vascular resistance (SVR) before, during and after drug infusion in combination with nt-pro-BNP before and 10 min after drug infusion. Depending on the nt-pro-BNP-levels b125 pg/ml (group A, n=34, 51±11 years) vs. nt-pro-BNP N125 pg/ml (group B, n=14, 63±7 years) two groups have been defined. Results: Trastuzumab therapy did not change nt-pro-BNP immediately before (44±29 pg/ml) vs. after the infusion (45±32 pg/ml, n.s.) in the low-level as in the high level nt-pro-BNP group (231±356 pg/ml prior and 240±377 pg/ml, n.s.). Cardiac output remained stable during trastuzumab infusion, however cardiac output was significantly increased following the end of the infusion stronger in the high-level nt-proBNP group. Systemic vascular resistance prior to the trastuzumab infusion was higher in the high-level nt-pro-BNP group with significant decrement during and after the infusion. Conclusion: Combining real-time CW-Doppler ultrasound and nt-pro-BNP monitoring is feasible to monitor the immediate hemodynamic changes during and after trastuzumab infusion. © 2007 Elsevier Ireland Ltd. All rights reserved.