A 52-year-old woman on adjuvant trastuzumab develops dyspnoea and an echocardiogram shows a fall in left ventricular ejection fraction from 62 percent to 44 percent. Which statement about this toxicity is correct?
- A It is usually irreversible and mandates permanent discontinuation of all cancer therapy
- B It occurs because trastuzumab intercalates into cardiac myocyte DNA
- C It is generally reversible with interruption of trastuzumab and heart failure therapy ✓
- D It is prevented by co-administration of dexrazoxane
Correct answer: C. It is generally reversible with interruption of trastuzumab and heart failure therapy
Explanation
Trastuzumab inhibits HER2 signalling, which cardiac myocytes need for repair and survival, producing a type II cardiomyopathy that is usually reversible with drug interruption and standard heart failure treatment. This contrasts with anthracycline type I injury, which is dose dependent and largely irreversible. Dexrazoxane protects against anthracycline cardiotoxicity, not trastuzumab cardiotoxicity. Risk rises when trastuzumab is given concurrently with anthracyclines, so they are sequenced instead.
Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.
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