A 48-year-old woman receiving adjuvant trastuzumab for HER2-positive breast cancer has a routine echocardiogram showing LVEF reduced from 62% to 48%. She completed anthracycline chemotherapy two years ago. Which statement about her cardiac dysfunction is correct?
- A It is typically reversible after stopping the drug, and cardiac function often recovers ✓
- B It is dose-dependent and usually irreversible, so trastuzumab must be stopped permanently
- C It indicates anthracycline-induced damage that was unmasked, unrelated to trastuzumab
- D It mandates immediate endomyocardial biopsy before any change in therapy
Correct answer: A. It is typically reversible after stopping the drug, and cardiac function often recovers
Explanation
Trastuzumab causes type II cardiotoxicity: it is not dose-cumulative, involves functional HER2 signalling loss rather than myocyte death, and is usually reversible on stopping the drug, with recovery aided by ACE inhibitors or beta blockers. Anthracycline cardiomyopathy is type I, dose-dependent, and largely irreversible due to free radical injury and apoptosis. The prior anthracycline increases susceptibility, but the reversible pattern identifies trastuzumab as the cause.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.