Somaira Nowsheen1, Paul V Viscuse2, Ciara C O'Sullivan3, Nicole P Sandhu4, Tufia C Haddad3, Anne Blaes5, Jennifer Klemp6, Lara Nhola7, Joerg Herrmann8, Kathryn J Ruddy3. 1. Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Medicine and the Mayo Clinic Medical Scientist Training Program. 2. Department of Medicine, Mayo Clinic. 3. Division of Oncology, Mayo Clinic. 4. Division of General Internal Medicine, Mayo Clinic. 5. Department of Medicine, University of Minnesota. 6. Division of Clinical Oncology, University of Kansas Medical Center. 7. Division of Cardiology Research, Mayo Clinic. 8. Department of Cardiovascular Diseases, Mayo Clinic.
Abstract
PURPOSE OF REVIEW: Treatment with trastuzumab is a cornerstone of human epidermal growth factor receptor 2 (HER2)-overexpressing breast cancer treatment, but carries an unfortunate risk of toxicity to the cardiovascular system. Here we review recent findings on trastuzumab-associated cardiotoxicity, focusing on its incidence, diagnosis, and treatment. RECENT FINDINGS: Screening with multigated acquisition scan (MUGA) or echocardiogram (ECHO) is recommended to assess cardiac function prior to and during trastuzumab therapy. Because trastuzumab-induced cardiotoxicity is typically reversible, cessation of trastuzumab and/or administration of first line heart failure agents effectively restores cardiac function in most cases. Severe trastuzumab-induced cardiotoxicity is rare enough that the risk-benefit ratio still weighs in favor of its use in the vast majority of patients with HER2+ breast cancer. SUMMARY: An improved understanding of the pathophysiology underlying trastuzumab-induced cardiotoxicity and the identification of patients at highest risk will allow us to continue to safely administer trastuzumab in patients with breast cancer.
PURPOSE OF REVIEW: Treatment with trastuzumab is a cornerstone of human epidermal growth factor receptor 2 (HER2)-overexpressing breast cancer treatment, but carries an unfortunate risk of toxicity to the cardiovascular system. Here we review recent findings on trastuzumab-associated cardiotoxicity, focusing on its incidence, diagnosis, and treatment. RECENT FINDINGS: Screening with multigated acquisition scan (MUGA) or echocardiogram (ECHO) is recommended to assess cardiac function prior to and during trastuzumab therapy. Because trastuzumab-induced cardiotoxicity is typically reversible, cessation of trastuzumab and/or administration of first line heart failure agents effectively restores cardiac function in most cases. Severe trastuzumab-induced cardiotoxicity is rare enough that the risk-benefit ratio still weighs in favor of its use in the vast majority of patients with HER2+ breast cancer. SUMMARY: An improved understanding of the pathophysiology underlying trastuzumab-induced cardiotoxicity and the identification of patients at highest risk will allow us to continue to safely administer trastuzumab in patients with breast cancer.
Entities:
Keywords:
HER2; breast cancer; cardio-oncology; cardiomyopathy; cardiotoxicity; trastuzumab
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