Management of Trastuzumab-Related Cardiac Dysfunction

Abstract 

Trastuzumab is the standard of care for the treatment of patients with ERB2-positive breast cancer. In a minority of patients, trastuzumab is associated with an increased incidence of cardiac dysfunction that ranges from asymptomatic decreases in left ventricular ejection fraction to symptomatic heart failure. In trials in the adjuvant setting, the difference in the incidence of cardiac events between the control and trastuzumab-containing arms was less than 4%. The baseline evaluation and oncologic setting (adjuvant versus metastatic disease) drive algorithms for the cardiac monitoring and management of these patients. When a patient develops documented left ventricular dysfunction, standard treatments for the management of heart failure should be prescribed. Trastuzumab cardiac dysfunction is an important clinical entity that can be managed effectively and individualized to maximize the cancer treatment benefit and minimize the risk and consequences of cardiac dysfunction.

Abbreviations and Acronyms: AC, anthracycline and cyclophosphamide, ACE, angiotensin-converting enzyme, ARB, angiotensin receptor blocker, BNP, brain natriuretic peptide, CHF, congestive heart failure, DFS, disease-free survival, ECHO, echocardiogram, ERB2, Human epidermal growth factor receptor 2, HER2, human epidermal growth factor receptor 2, HF, symptomatic heart failure, HR, hazard ratio, LLN, lower limit of normal, LVEF, left ventricular ejection fraction, MUGA, multiple gated acquisition, MBC, metastatic breast cancer, NYHA, New York Heart Association, OS, overall survival

Keywords: Trastuzumab, ERB2, Signal transduction, Cardiac dysfunction, Heart failure, Cardiac output, Breast cancer