Tesis

Analisis Faktor Risiko Terjadinya Kardiotoksik pada Pasien Kanker Payudara HER2 (+) yang Mendapatkan Trastuzumab di RS Kanker Dharmais = Risk Factors for Cardiotoxicity in HER2-Positive Breast Cancer Patients Receiving Trastuzumab at Dharmais Cancer Hospital.

Pendahuluan: Trastuzumab merupakan terapi target standar untuk kanker payudara HER2 positif yang terbukti meningkatkan angka harapan hidup, namun berisiko menimbulkan kardiotoksisitas berupa penurunan fraksi ejeksi ventrikel kiri (LVEF). Evaluasi faktor risiko penting untuk mengidentifikasi pasien yang rentan terhadap efek samping ini. Metode: Penelitian ini merupakan studi retrospektif dengan desain potong lintang berbasis data sekunder dari rekam medis pasien kanker payudara HER2 positif yang menerima trastuzumab di RS Kanker Dharmais selama tahun 2023. Data mencakup karakteristik pasien, riwayat komorbid, jenis terapi, serta hasil ekokardiografi sebelum dan sesudah terapi trastuzumab. Analisis menggunakan uji bivariat dan multivariat untuk menilai hubungan antara faktor risiko dan kejadian kardiotoksisitas. Hasil: Sebanyak 118 subjek yang memenuhi persyaratan kriteria inklusi dianalisis. Prevalensi kardiotoksisitas ditemukan pada 18 subjek (15,3%). Usia ≥ 60 tahun berhubungan signifikan dengan kejadian kardiotoksisitas (p=0,025; OR 3,2; IK95% 1,119–9,153). Faktor lain seperti IMT, riwayat komorbid, penggunaan antrasiklin, penggunaan obat kardioprotektif, dosis kumulatifantrasiklin, riwayat dan lokasi radiasi, serta jumlah pemberian trastuzumab tidak menunjukkan hubungan bermakna secara statistik. Kesimpulan: Trastuzumab merupakan terapi yang efektif, dengan angka kardiotoksisitas 15,3%. Usia ≥ 60 tahun terbukti sebagai faktor risiko signifikan, sedangkan faktor lain tidak bermakna. Temuan ini menekankan pentingnya pemantauan kardiovaskular ketat pada pasien usia lanjut.
Kata kunci: Trastuzumab, kanker payudara HER2 positif, kardiotoksisitas, LVEF, faktor risiko


Introduction: Trastuzumab is the standard targeted therapy for HER2-positive breast cancer and has been proven to improve survival rates. However, its use carries a risk of cardiotoxicity, particularly a decrease in left ventricular ejection fraction (LVEF). Evaluating risk factors is essential to identify patients vulnerable to these adverse effects. Methods: This retrospective cross-sectional study used secondary data from the medical records of HER2-positive breast cancer patients who received trastuzumab at Dharmais Cancer Hospital in 2023. Collected data included patient characteristics, comorbidities, type of therapy, and echocardiographic results before and after trastuzumab. Bivariate and multivariate analyses were conducted to assess the association between risk factors and cardiotoxicity. Results: A total of 118 subjects who met the inclusion criteria were analyzed. Cardiotoxicity was observed in 18 subjects (15.3%). Age ≥60 years was significantly associated with cardiotoxicity (p=0.025; OR 3.2; 95% CI 1.119–9.153). Other factors such as BMI, comorbidities, anthracycline use, cardioprotective medications, cumulative anthracycline dose, history and site of radiation, and number of trastuzumab cycles showed no statistically significant association. Conclusion: Trastuzumab is an effective therapy with a cardiotoxicity rate of 15.3%. Age ≥ 60 years was identified as a significant risk factor, while other factors were not statistically significant. These findings highlight the importance of close cardiovascular monitoring in elderly patients receiving trastuzumab
Keywords: Trastuzumab, HER2-positive breast cancer, cardiotoxicity, LVEF, risk factors