title: Cardiomyopathy Associated With Targeted Therapy for Breast Cancer.
abstract: BACKGROUND
  Chemotherapeutic agents directed against human epidermal growth factor receptor 2 (HER-2) have significantly improved the prognosis of patients who are positive for this receptor. However, cardiomyopathy remains as a common adverse effect of using these agents.
  
  
  METHODS
  Literature search was conducted via PubMed using the keywords of "Trastuzumab Cardiomyopathy," "Lapatinib Cardiomyopathy" and "Pertuzumab Cardiomyopathy," which provided 104 results. These articles were then screened for relevance to the targeted subject based on their title and abstracts. Case reports and articles that were not discussing any aspect of cardiomyopathy secondary to targeted therapy for breast cancer and articles not in English were eliminated. After elimination, a bibliography search among selected articles was done and a total of 46 articles were identified. The collected articles were then meticulously analyzed and summarized.
  
  
  RESULTS
  The use of human epidermal growth factor receptor 2 (HER-2) receptor targeted chemotherapy in breast cancer is limited because of a higher incidence (19-22%) of cardiomyopathy. The incidence of cardiomyopathy is not dose dependent and in most cases it is reversible after discontinuation of the drug and treatment with heart failure medications. Severe adverse outcomes including death or permanent disability are rare.
  
  
  CONCLUSIONS
  HER-2 targeted chemotherapy for breast cancer has a higher incidence of associated reversible cardiomyopathy. Patients should be monitored by serial echocardiography starting at the beginning of the treatment and followed by every 3 months until the completion of chemotherapy. Co-ordination between oncologists and cardiologists is needed to develop evidence-based protocols to prevent, identify, monitor and treat trastuzumab-induced cardiomyopathy.
authors.affiliation: Division of Cardiology, East Tennessee State University, Johnson City, Tennessee.
authors.forename: Kamesh
authors.initials: K
authors.lastname: Sivagnanam
authors.affiliation: Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee.
authors.forename: Zia U
authors.initials: ZU
authors.lastname: Rahman
authors.affiliation: Division of Cardiology, East Tennessee State University, Johnson City, Tennessee. Electronic address: pault@etsu.edu.
authors.forename: Timir
authors.initials: T
authors.lastname: Paul
mesh_terms: D001943:Breast Neoplasms / Q000188:drug therapy*; D009202:Cardiomyopathies / Q000139:chemically induced / Q000188:drug therapy / Q000453:epidemiology*; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D058990:Molecular Targeted Therapy / Q000009:adverse effects; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D018719:Erb-b2 Receptor Tyrosine Kinases; C508053:ERBB2 protein, human
keywords: Breast cancer; Cardiomyopathy; Lapatinib; Pertuzumab; Trastuzumab