Adjuvant Trastuzumab Therapy: Can We Balance Efficacy and Safety?

Oncologist. 2019 Nov;24(11):1405-1409. doi: 10.1634/theoncologist.2019-0263. Epub 2019 Jul 17.

Abstract

Trastuzumab is an effective treatment for HER2-positive breast cancer. Current guidelines recommend withholding trastuzumab in patients experiencing a significant asymptomatic decline in left ventricular function. In this commentary, we discuss the survival benefits afforded by trastuzumab juxtaposed against the risk of trastuzumab-mediated cardiotoxicity. It is not known whether the net benefit of continuing trastuzumab in the setting of mild cardiotoxicity outweighs the associated risks. We describe a potential approach undertaken by our group, and others, and call for a randomized trial.

Keywords: Breast cancer; Cardiotoxicity; Cardio‐oncology; HER2; Trastuzumab.

MeSH terms

  • Antineoplastic Agents, Immunological / adverse effects*
  • Breast Neoplasms / drug therapy*
  • Breast Neoplasms / pathology
  • Cardiotoxicity / etiology*
  • Cardiotoxicity / prevention & control*
  • Chemotherapy, Adjuvant
  • Dose-Response Relationship, Drug
  • Female
  • Heart Failure / etiology
  • Heart Failure / prevention & control*
  • Humans
  • Patient Safety
  • Prognosis
  • Trastuzumab / adverse effects*

Substances

  • Antineoplastic Agents, Immunological
  • Trastuzumab