A 52-year-old woman on adjuvant trastuzumab develops a declining left ventricular ejection fraction from 62% to 48%. Which feature best distinguishes trastuzumab-induced cardiac dysfunction from anthracycline-induced cardiomyopathy?
- A It is often reversible after stopping the drug and responds to heart failure therapy ✓
- B It is dose-dependent and usually irreversible
- C It presents primarily as diastolic dysfunction
- D It occurs only when given concurrently with anthracyclines
Correct answer: A. It is often reversible after stopping the drug and responds to heart failure therapy
Explanation
HER2 signalling is important for survival and repair of cardiac myocytes, so trastuzumab causes a type II cardiotoxicity that is generally not dose-dependent and frequently reverses after drug withdrawal, with recovery aided by ACE inhibitors or beta blockers. Anthracycline injury is dose-dependent, cumulative, and typically irreversible. Concurrent anthracycline plus trastuzumab markedly increases risk, but trastuzumab cardiotoxicity also occurs without anthracyclines.
Reference: Katzung Basic and Clinical Pharmacology, 16th ed.
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