Trastuzumab Induced Cardiotoxicity - A Case Series

Trastuzumab has become the treatment of choice for HER-2+ metastatic breast cancer with increased progression free survival and overall survival compared to conventional chemotherapy treatment. Unfortunately, cardio toxicity was reported from western countries following Trastuzumab and Pertuzumab therapy. We describe 4 case studies where patients developed cardiotoxicity following treatment with Trastuzumab and its management. Additive effect of pertuzumab on cardiac dysfunction was observed especially in patients with prior long-term trastuzumab treatments. Pertuzumab when co-administered with trastuzumab worsen the scenario by causing a progressive decline in LV ejection fraction within a shorter follow-up timeline. In all four cases there were significant reduction in Left ventricular ejection fractions and it was reversed when Lapatinib was substituted for trastuzumab and with additional medications betablocker and Ivabradine. Evaluation of risk factors for cardiac toxicity before initiation and periodic monitoring of cardiac functions need to be conducted especially left ventricular ejection fraction as early withdrawal of trastuzumab and appropriate remedial measures could reverse the cardiac toxicity in Indian population as well.