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

  • Pierantonio Menna
  • Giorgio MinottiEmail author
  • Emanuela Salvatorelli
Myocardial Disease (A Abbate and G Sinagra, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Myocardial Disease

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.

Keywords

Targeted drugs Cardiotoxicity Trastuzumab 

Notes

Compliance with Ethical Standards

Conflict of Interest

Pierantonio Menna, Giorgio Minotti, and Emanuela Salvatorelli declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019
corrected publication 2019

Authors and Affiliations

  • Pierantonio Menna
    • 1
  • Giorgio Minotti
    • 1
    • 2
    • 3
    Email author
  • Emanuela Salvatorelli
    • 2
  1. 1.Clinical Pharmacology UnitCampus Bio-Medico University HospitalRomeItaly
  2. 2.Department of Medicine, Unit of Drug Sciences and Center for Integrated ResearchUniversity Campus Bio-MedicoRomeItaly
  3. 3.Department of Medicine and Units of Drug Sciences and Clinical PharmacologyUniversity Campus Bio-MedicoRomeItaly

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