Detection, monitoring, and management of trastuzumab-induced left ventricular dysfunction: an actual challenge.
The antibody trastuzumab, targeted to inhibit the signalling of ErbB2, a tyrosine kinase receptor overexpressed in 20-30% of breast cancers, improves the prognosis in women affected by this tumour, but produces cardiotoxicity, since ErbB2 is also involved in myocardial homeostasis. In this review, we discuss the pathophysiology of trastuzumab cardiomyopathy and the complex interplay between ErbB2 inhibition and anthracyclines, and we focus on the actual challenges of detecting, monitoring, and managing trastuzumab cardiotoxicity: the research of new, sensitive markers of early trastuzumab toxicity, before the ejection fraction is reduced, is an active field of research.
Division of Cardiology, National Cancer Institute, Sen. Pascale Foundation, Naples, Italy. cgtocchetti@iol.it
Carlo G
CG
Tocchetti
Gianluca
G
Ragone
Carmela
C
Coppola
Domenica
D
Rea
Giovanna
G
Piscopo
Stefania
S
Scala
Claudia
C
De Lorenzo
Rosario V
RV
Iaffaioli
Claudio
C
Arra
Nicola
N
Maurea
D000465:Algorithms; D018943:Anthracyclines / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D015415:Biomarkers / Q000032:analysis; D009202:Cardiomyopathies / Q000139:chemically induced / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D008991:Monitoring, Physiologic; D032383:Myocytes, Cardiac / Q000187:drug effects; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000037:antagonists & inhibitors*; D000068878:Trastuzumab; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy
D018943:Anthracyclines; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D015415:Biomarkers; D018719:Erb-b2 Receptor Tyrosine Kinases; D000068878:Trastuzumab; C508053:ERBB2 protein, human