# Trastuzumab cardiotoxicity

Source: https://onco.cc/terms/trastuzumab-cardiotoxicity/  
OnCo record `trastuzumab-cardiotoxicity` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

HER2 drugs can weaken the heart's pumping, usually reversibly, so heart function is checked every three months during treatment.

## Summary

Asymptomatic LVEF decline in 10-15% and symptomatic heart failure in 1-4% with trastuzumab, higher with prior or concurrent anthracyclines (NSABP B-31: 4.1% vs 0.8%). Mechanism: HER2 signalling maintains cardiomyocyte survival under stress. Management: hold for LVEF drop ≥16 points or below normal, ACE inhibitors/beta-blockers, rechallenge after recovery; anthracycline-free regimens (TCHP, T-DXd neoadjuvant) reduce risk.

## Fields

- Kind: Term
- Last checked: 2026-09-07

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Trastuzumab
- ClinicalTrials.gov NCT00712140: PERSEPHONE: https://clinicaltrials.gov/study/NCT00712140

## Connected records

- cancers: [Early HER2-positive breast cancer](https://onco.cc/cancers/her2-positive-early-breast-cancer/), [HER2-positive breast cancer](https://onco.cc/cancers/breast-her2-positive/)
- technologies: [Cardio-oncology](https://onco.cc/technologies/cardio-oncology/), [Heart function after anthracyclines, trastuzumab and chest radiotherapy](https://onco.cc/technologies/cardiotoxicity-surveillance-recovery/), [Protecting the heart during anthracycline treatment: dexrazoxane, beta blockers and ACE inhibitors](https://onco.cc/technologies/anthracycline-cardioprotection/)
- drugs: [Pertuzumab](https://onco.cc/drugs/pertuzumab/), [Trastuzumab](https://onco.cc/drugs/trastuzumab/)
- trials: [PERSEPHONE](https://onco.cc/trials/persephone/)
- bottlenecks: [Cachexia, toxicity and the limits of the patient](https://onco.cc/bottlenecks/b-cachexia-supportive/), [Survivorship and late effects are neglected](https://onco.cc/bottlenecks/b-survivorship/)

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