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 < 125 pg/ml (group A, n = 34, 51 ± 11 years) vs. nt-pro-BNP > 125 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-pro-BNP 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.