Trastuzumab therapy and the heart: palliation at what cost?

Trastuzumab (Herceptin®), a monoclonal HER2 receptor blocker, was approved by the Food and Drug Administration in September, 1998 for the treatment of advanced breast carcinoma. It is rapidly emerging as an important drug for the treatment of metastatic breast cancer. The results of a pivotal trial revealed a 53% improvement in the response rate when trastuzumab was added to the standard chemotherapeutic regimen. However, a greater than four-fold increase in the occurrence of congestive heart failure was also noted. This novel agent has ushered in hope for thousands of women, but its use mandates that a clear understanding of its effects and relative risks be appreciated. Careful patient selection for the use of trastuzumab is critically important. It is prudent that cardiologists be aware of its cardiotoxicity, and that the risk/benefit ratio be clarified before its use in less invasive forms of breast cancer. (c)2001 CHF, Inc.