Risk factors for trastuzumab cardiotoxicity

Risk factors for trastuzumab cardiotoxicity

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Trastuzumab is a monoclonal antibody targeting the HER2 (human epidermal growth factor receptor 2) used in the treatment of HER2 positive breast cancer. The drug when used in the treatment of early stage breast cancer, reduces recurrences by half and mortality by one third. But trastuzumab trials have shown severe heart failure or cardiac event rate up to 3.9%.

Important risk factors for cardiotoxicity with trastuzumab treatment are:

  1. Age above 50 years
  2. Underlying heart disease or hypertension
  3. Baseline left ventricular ejection fraction 50-55% or lower
  4. Previous anthracycline therapy


  1. Laxmi S. Mehta, Karol E. Watson, Ana Barac, Theresa M. Beckie, Vera Bittner, Salvador Cruz-Flores, Susan Dent, Lavanya Kondapalli, Bonnie Ky, Tochukwu Okwuosa, Ileana L. Piña, Annabelle Santos Volgman
    and On behalf of the American Heart Association Cardiovascular Disease in Women and Special Populations Committee of the Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; and Council on Quality of Care and Outcomes Research. Cardiovascular Disease and Breast Cancer: Where These Entities Intersect: A Scientific Statement From the American Heart Association. Circulation. 2018;137:e30-e66.