佐剂曲妥珠单抗（赫赛汀）是人表皮生长因子受体2阳性的早期乳腺癌(HER2+EBC)化疗的金标准。年纪大的乳腺癌患者（60岁以上）因病例数目不足一直缺乏临床实验证据，因此尚没有研究数据显示该人群中的曲妥珠单抗（赫赛汀）的心脏毒性。

    发表在Annals Oncology杂志上的一篇文章对老龄乳腺癌患者使用曲妥珠单抗（赫赛汀）的心脏毒性进行了研究。499名HER2+乳腺癌患者在意大利的10家医疗机构连续接受佐剂曲妥珠单抗（赫赛汀）的化疗。研究人员评估了60岁以上患者使用赫赛汀后发生心脏毒性风险的机率。

    结果显示，160名（32%）60岁以上的患者中，表现出较高发生的高血压、糖尿病、肾功能不全和血脂异常。60岁以上的患者中，有6%发生心衰，而年轻组的患者只有2%。33%的60岁以上患者组左室射血分数受到影响，而在年轻组，只有23%受影响。

    在该项临床实验中，32%的使用曲妥珠单抗（赫赛汀）化疗的人表皮生长因子受体2阳性的早期乳腺癌(HER2+EBC)患者年龄在60岁以上，这些病人表现为增高的心脏风险，一般发展为佐剂曲妥珠单抗（赫赛汀）心脏毒性损害。

    Adjuvant trastuzumab cardiotoxicity in patients over 60 years of age with early breast cancer: a multicenter cohort analysis

    Background: Adjuvant Trastuzumab with chemotherapy is the gold standard for human epidermal growth factor receptor 2 (HER2)-positive early breast cancer (HER2+ EBC). Older patients have been largely under-represented in clinical trials, and few data on Trastuzumab cardiotoxicity have been reported in this subgroup.

    Patients and methods: Four hundred and ninety-nine consecutive HER2+ EBC patients were treated with adjuvant trastuzumab and chemotherapy (aTrastC) at 10 Italian institutions. We evaluated disease prevalence and patient characteristics in the patients older than 60 years of age (over-60), prevalence of aTrastC cardiotoxicity and risk factors.

    Results: There were 160 ‘over-60’ patients (32%), in whom a higher prevalence of hypertension, diabetes, renal dysfunction, dyslipidemia and treatment with ACEi (40 versus 8%) and beta blockers (20 versus 8%) was found than in the younger patients (339 = 68%). Clinical heart failure occurred in 6% of the ‘over-60’ and in 2% of the younger patients. A reduction in left ventricular ejection fraction of >10 points was detected in 33% of the ‘over-60’ and in 23% of the younger patients (all P < 0.05). aTrastC was discontinued in 10% of the ‘over-60’ and in 4% of the younger patients (P = 0.003), restarted in 44% of the ‘over-60’ and in 58% of the younger women (P = ns).

    Conclusion: In clinical practice, 32% of HER2+ EBC patients treated with aTrastC are ‘over-60’. These patients have an increased cardiovascular risk profile and develop aTrastC cardiotoxicity commonly.