Twenty years of anti-HER2 therapy-associated cardiotoxicity

Area of Science:

• Oncology
• Cardiology
• Pharmacology

Background:

• HER2-positive breast cancer prognosis improved with anti-HER2 therapies like trastuzumab.
• Early trials revealed significant cardiotoxicity concerns with trastuzumab, particularly when combined with anthracyclines.
• Despite risk reduction strategies, cardiotoxicity remains a clinical challenge with increasing patient survival and new agent approvals.

Approach:

• This article provides a comprehensive review of anti-HER2 therapy-related cardiotoxicity.
• It synthesizes data from clinical trials involving trastuzumab and newer anti-HER2 agents.
• The review aims to elucidate the physiopathology mechanisms of cardiotoxicity, which are not fully understood.

Key Points:

• Trastuzumab, the first anti-HER2 agent, was associated with high rates of cardiac events and congestive heart failure in early studies.
• Subsequent trials demonstrated reduced cardiac event incidence through optimized chemotherapy, patient selection, and cardiac monitoring.
• Cardiotoxicity is an evolving issue, expected to grow with expanded use of anti-HER2 therapies and improved patient longevity.

Conclusions:

• Anti-HER2 therapies offer significant survival benefits for HER2-positive breast cancer patients.
• Managing cardiotoxicity is crucial for long-term patient outcomes.
• Further research into the underlying mechanisms of cardiotoxicity is needed to develop more effective preventative and therapeutic strategies.