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Cardiotoxicity of Targeted Cancer Drugs: Concerns, “The Cart Before the Horse,” and Lessons from Trastuzumab

  • Myocardial Disease (A Abbate and G Sinagra, Section Editors)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

A Correction to this article was published on 15 April 2019

This article has been updated

Abstract

Purpose of Review

Modern oncology is witnessing a renaissance of its pharmacologic armamentarium. Old generation drugs, such as anthracyclines and other cytotoxic or cytostatic drugs, were plagued with a lack of specificity and with the possible occurrence of untoward effects in the cardiovascular system and other healthy tissues. The old drugs are now combined with, or replaced by, new agents that are more specific in attacking some unique moieties and vital functions of cancer cells, causing less noxious effects in healthy tissues. Regrettably, however, the new “targeted” drugs still cause varying levels of cardiac or vascular toxicity. Here, we describe the case of trastuzumab, a monoclonal antibody that dramatically improved the life expectancy of women with Erbb2-overexpressing breast tumor, while also raising concerns about a possible incidence of cardiac dysfunction.

Recent Findings

The scientific community counts experts that label trastuzumab as a “cardiotoxic agent” and other experts that maintain a more benign assessment. We describe the biologic foundations and clinical evidence for such controversy. We show that trastuzumab cardiotoxicity is probably overrated, leading some experts to raise unjustified overconcerns about the cardiotoxicity of trastuzumab as a single agent or in combination with anthracyclines or other old and new drugs. We analyze the biases that caused trastuzumab cardiotoxicity to be overrated.

Summary

Trastuzumab is a life-saving agent showing a moderate and clinically manageable cardiac dysfunction, and yet, it is portrayed as cardiotoxic. We take the trastuzumab lesson to reaffirm that cardio-oncologists should provide cancer patients with the best therapeutic opportunity, as is the case for trastuzumab, while also devising the necessary strategies of risk assessment and mitigation.

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Change history

  • 15 April 2019

    In the original publication, there were two errors in Fig. 2. “Anhracyline” should be “Anthracycline” and “targetd” should be “targeted.” The original article has been corrected.

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Author notes

  1. Pierantonio Menna, Giorgio Minotti and Emanuela Salvatorelli contributed equally to this work.

Authors and Affiliations

  1. Clinical Pharmacology Unit, Campus Bio-Medico University Hospital, Rome, Italy

    Pierantonio Menna & Giorgio Minotti

  2. Department of Medicine, Unit of Drug Sciences and Center for Integrated Research, University Campus Bio-Medico, Rome, Italy

    Giorgio Minotti & Emanuela Salvatorelli

  3. Department of Medicine and Units of Drug Sciences and Clinical Pharmacology, University Campus Bio-Medico, Via Alvaro del Portillo, 21, 00128, Rome, Italy

    Giorgio Minotti

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  1. Pierantonio Menna
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Correspondence to Giorgio Minotti.

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The original version of this article was revised: There was an error in Figure 2. “Anhracyline” should be “Anthracycline” and “targetd” should be “targeted.”

This article is part of the Topical Collection on Myocardial Disease

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Menna, P., Minotti, G. & Salvatorelli, E. Cardiotoxicity of Targeted Cancer Drugs: Concerns, “The Cart Before the Horse,” and Lessons from Trastuzumab. Curr Cardiol Rep 21, 33 (2019). https://doi.org/10.1007/s11886-019-1121-0

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