title: Cardiotoxic  effects of trastuzumab.
abstract: BACKGROUND
  Breast cancer with overexpression of the HER2 receptor is an aggressive type of breast cancer with poor prognosis. Trastuzumab (Herceptin) is a monoclonal antibody that binds to the HER2 receptor on the cell surface blocking the signals that promote cell-growth proliferation. Trastuzumab treatment has almost halved the risk of relapse, when given as an adjuvant, and has improved the overall survival in metastatic breast cancer. However, when given alone or in combination with cardiotoxic chemotherapy, especially anthracyclines, trastuzumab may lead to congestive heart failure of varying severity.
  
  
  METHODS
  The article is a non-systematic review of articles from clinical trails, basic research, and recommendations by Norwegian and international expert panels.
  
  
  RESULTS
  The cardiotoxic effects of trastuzumab and anthracycline in combination were already reported in the pivotal trials. Over ten years of research have revealed the mechanisms of cardiotoxicity with trastuzumab. Risk factors have been identified and recommendations drawn up for cardiac surveillance and treatment of patients with signs of heart failure. By following these recommendations the incidence of heart failure is reduced to approximately five per cent of treated patients.
  
  
  CONCLUSIONS
  In summary, the favourable effects of trastuzumab are convincing, but cardiotoxicity is a significant challenge in treatment. Risk factors for side effects indicate extra vigilance, but the side effects are unpredictable and all patients treated with trastuzumab must undergo regular cardiac surveillance.
authors.affiliation: Medisinsk avdeling, Sykehuset Telemark, Skien. jan.hysing@sthf.no
authors.forename: Jan
authors.initials: J
authors.lastname: Hysing
authors.forename: Erik
authors.initials: E
authors.lastname: Wist
mesh_terms: D018943:Anthracyclines / Q000008:administration & dosage / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000556:secondary; D054715:Cardiotoxins / Q000008:administration & dosage / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006333:Heart Failure / Q000139:chemically induced* / Q000517:prevention & control; D006801:Humans; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D000068878:Trastuzumab
chemical_list: D018943:Anthracyclines; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D054715:Cardiotoxins; D000068878:Trastuzumab