Question:
A woman with breast cancer is being treated with trastuzumab. Which of the following statements regarding its cardiotoxicity is correct?
A woman with breast cancer is being treated with trastuzumab. Which of the following statements regarding its cardiotoxicity is correct?
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Due to the risk of cardiotoxicity, patients on Trastuzumab require baseline and serial monitoring of their LVEF via echocardiography (typically every 3 months). If LVEF drops significantly (usually $>$ 10-15% from baseline or below 50%), the drug should be held temporarily.
Updated On: Sep 3, 2026
- Reversible
- Myocyte destruction
- Irreversible
- Dose dependent
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The Correct Option is A
Solution and Explanation
Concept:
Trastuzumab is a monoclonal antibody that targets the HER2/neu (ERBB2) receptor. It is a cornerstone in the treatment of HER2-positive breast cancer.
The most significant adverse effect of trastuzumab therapy is cardiotoxicity, which manifests as a decline in the Left Ventricular Ejection Fraction (LVEF) and can occasionally lead to symptomatic heart failure.
Explanation:
• Chemotherapy-induced cardiotoxicity is broadly classified into two types.
• Type I Cardiotoxicity is classically caused by Anthracyclines (like Doxorubicin). It involves direct oxidative stress leading to irreversible myocyte necrosis and destruction. Crucially, Type I toxicity is highly dose-dependent (the risk increases exponentially past a certain cumulative lifetime dose).
• Type II Cardiotoxicity is classically caused by Trastuzumab.
• Trastuzumab toxicity does NOT cause ultrastructural damage or myocyte necrosis. Instead, it temporarily stuns the myocardium by interfering with HER2 signaling, which is required for cardiomyocyte repair and survival under stress.
• Because there is no structural cell death, Type II cardiotoxicity is generally completely reversible upon discontinuation of the drug and the initiation of standard heart failure medications.
• Furthermore, Trastuzumab toxicity is not dependent on the cumulative lifetime dose.
• Therefore, options (B), (C), and (D) describe Anthracycline (Type I) toxicity, whereas option (A) accurately describes Trastuzumab (Type II) toxicity.
Final answer:
Trastuzumab causes a Type II cardiotoxicity, which is characteristically reversible once the medication is stopped.
Trastuzumab is a monoclonal antibody that targets the HER2/neu (ERBB2) receptor. It is a cornerstone in the treatment of HER2-positive breast cancer.
The most significant adverse effect of trastuzumab therapy is cardiotoxicity, which manifests as a decline in the Left Ventricular Ejection Fraction (LVEF) and can occasionally lead to symptomatic heart failure.
Explanation:
• Chemotherapy-induced cardiotoxicity is broadly classified into two types.
• Type I Cardiotoxicity is classically caused by Anthracyclines (like Doxorubicin). It involves direct oxidative stress leading to irreversible myocyte necrosis and destruction. Crucially, Type I toxicity is highly dose-dependent (the risk increases exponentially past a certain cumulative lifetime dose).
• Type II Cardiotoxicity is classically caused by Trastuzumab.
• Trastuzumab toxicity does NOT cause ultrastructural damage or myocyte necrosis. Instead, it temporarily stuns the myocardium by interfering with HER2 signaling, which is required for cardiomyocyte repair and survival under stress.
• Because there is no structural cell death, Type II cardiotoxicity is generally completely reversible upon discontinuation of the drug and the initiation of standard heart failure medications.
• Furthermore, Trastuzumab toxicity is not dependent on the cumulative lifetime dose.
• Therefore, options (B), (C), and (D) describe Anthracycline (Type I) toxicity, whereas option (A) accurately describes Trastuzumab (Type II) toxicity.
Final answer:
Trastuzumab causes a Type II cardiotoxicity, which is characteristically reversible once the medication is stopped.
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