Cardiac toxic effects from paclitaxel with trastuzumab, presenting as grade 3 or 4 left ventricular systolic dysfunction (LVSD) or asymptomatic left ventricular ejection fraction decline (LVEF), were low in patients with node-negative, ERBB2-positive breast cancer, a new study published online ahead of print in JAMA Oncology has shown.1

Although trastuzumab is a life-saving therapy for many patients with ERBB2- (formerly human epidermal growth factor receptor 2 [HER2]) positive breast cancer, it is often associated with symptomatic and asymptomatic left ventricular ejection fraction (LVEF) decline.

Therefore, researchers sought to evaluate the cardiotoxic effects of a trastuzumab-based treatment without an anthracycline for early stage ERBB2-positive breast cancer.

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Researchers analyzed data from an uncontrolled, single-group study that enrolled 406 patients with node-negative, ERBB2-positive breast cancer that was 3 cm or smaller, and baseline LVEF 50% or higher.

Patients with a micrometastasis in a lymph node were also eligible to participate. All patients received adjuvant weekly paclitaxel for 12 weeks with trastuzumab, followed by trastuzumab monotherapy at a dose of 2 mg/kg weekly or 6 mg/kg every 3 weeks. Researchers assessed participants’ LVEF at baseline, 12 weeks, 6 months, and 1 year.

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Results showed that overall, only 0.5% (95% CI, 0.1 – 1.8) of patients developed grade 3 LVSD and 3.2% (95% CI, 1.9 – 5.4) developed significant asymptomatic LVEF decline. Researchers found that median LVEF at baseline was 65% and was 64% at 12 weeks, 6 months, and 1 year.

“Our findings suggest that LVEF monitoring during trastuzumab therapy without anthracyclines could be simplified for many individuals,” the authors concluded.


  1. Dang C, Guo H, Najita J, et al. Cardiac outcomes of patients receiving adjuvant weekly paclitaxel and trastuzumab for node-negative, ERBB2-positive breast cancer [published online ahead of print November 5, 2015]. JAMA Oncol. doi: 10.1001/jamaoncol.2015.3709.