Her-2 positive breast cancer and trastuzumab: Lessons learnt by heart
Women treated with trastuzumab have an increased risk for developing cardiac problems, particularly if they receive prior or concurrent anthracyclines. Left ventricular dysfunction associated with trastuzumab treatment may progress to severe New York Heart Association (NYHA) class III/IV heart failure which carries its own chronic disability and mortality. Whilst it would appear that the cardiac dysfunction is partially reversible and responds to standard medication, its natural course is currently unknown and longer term data are required. Preclinical studies have attempted to elucidate trastuzumabs mechanism of cardiotoxity and this is an area of innovative research. Myocardial HER-2 receptors are crucial for embryonic cardiac development and for maintaining adult ventricular structure and function. It is thought that sequential stress mechanisms may contribute to the pathogenesis of cardiac dysfunction. The challenge remains to identify the risks and to tailor trastuzumab treatment for each patient, to conscientiously monitor cardiac function and to institute appropriate measures if necessary, in order to ensure that HER-2 positive breast cancer patients receive the best possible care.