Cardiotoxicity and Herceptin

As with many monoclonal antibodies, Herceptin can increase the risk of congestive heart failure. One clinical study of cardiotoxicity and Herceptin showed that up to 16 percent of people had to stop taking the medication due to heart problems. Specifically, Herceptin increases problems in the left ventricle of the heart. This risk of heart problems was the highest in people taking Herceptin along with anthracyclines (chemotherapy medications).

 

Cardiotoxicity and Herceptin: An Introduction

Herceptin® (trastuzumab) is a prescription medication used to treat breast cancer. It is part of a group of medications called monoclonal antibodies. As with other monoclonal antibodies, Herceptin can increase the risk of congestive heart failure (CHF).
 

Cardiotoxicity and Herceptin Research

One study showed that up to 16 percent of people stopped taking Herceptin due to heart problems. In particular, Herceptin seems to increase the risk of left ventricular dysfunction (problems in the left ventricle of the heart). The risk of heart failure was highest in people taking Herceptin along with anthracyclines (chemotherapy medications that also increase the risk of heart problems). In one study, combining Herceptin with doxorubicin (Adriamycin®, Rubex®) and cyclophosphamide (Cytoxan®) increased the risk of congestive heart failure by up to 28 percent.
 
Due to the increased risk of cardiotoxicity, Herceptin and anthracyclines (including doxorubicin) should not be given at the same time. Doxorubicin therapy should be completed before starting Herceptin.
 

Monitoring for Cardiotoxicity With Herceptin

The manufacturer of Herceptin recommends a thorough cardiovascular assessment, consisting of a physical examination and either an echocardiogram or MUGA scan (tests to assess heart function) before starting Herceptin. Monitoring is suggested at each of the following times:
 
  • Before starting doxorubicin (Adriamycin, Rubex) and cyclophosphamide (Cytoxan), which are often used before starting Herceptin
  • Before starting Herceptin
  • Three months after starting Herceptin along with paclitaxel (Onxol®, Taxol®)
  • Three months after taking Herceptin alone (after stopping paclitaxel)
  • Three months after stopping Herceptin.
     
(Cardiotoxicity and Herceptin Continued: Page 2)
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Written by/reviewed by: Kristi Monson, PharmD; Arthur Schoenstadt, MD
Last reviewed by: Kristi Monson, PharmD;