Anthracycline, Trastuzumab, and Cardiovascular Toxicity

In cancer treatment, the pervasive late effects of radiation and chemotherapy limit their utility, especially in children, in whom treatment often leads to lifelong morbidity and excess mortality. Advances in understanding the molecular pathways related to tumorigenesis have led to the development of targeted therapies, but recurrent late effects, as in the case of trastuzumab, and unexpectedly high rates of cardiotoxicity highlight gaps in our understanding of drug pathways and the mechanisms of treatment toxicity. Here, we review the mechanisms of anthracycline activity in tumor and cardiac cells, as well as the clinical manifestations and their associated cardiotoxicity, prevention strategies, and monitoring recommendations. We also describe the cardiac effects of trastuzumab with specific attention to its interaction with anthracyclines.