Trastuzumab and target-therapy side effects: Is still valid to differentiate anthracycline Type I from Type II cardiomyopathies?

Hum Vaccin Immunother. 2016 May 3;12(5):1124-31. doi: 10.1080/21645515.2015.1125056. Epub 2016 Feb 2.


The improvement in cancer therapy and the increasing number of long term survivors unearth the issue of cardiovascular side effects of anticancer treatments. As a paradox in cancer survivors, delayed cardiotoxicity has emerged as a significant problem. Two categories of cardiotoxic side effects of antineoplastic drugs have been previously proposed: Type I cardiotoxicity, defined as permanent cardiotoxicity, is usually caused by anthracyclines; Type II cardiotoxicity, considered as reversible cardiotoxicity, has been mainly related to monoclonal antibodies. The cardiotoxicity of antibodies has been associated to trastuzumab, a humanized anti-ErbB2 monoclonal antibody currently in clinical use for the therapy of breast carcinomas, which induces cardiac dysfunction when used in monotherapy, or in combination with anthracyclines. Furthermore, recent retrospective studies have shown an increased incidence of heart failure and/or cardiomyopathy in patients treated with trastuzumab, that can persist many years after the conclusion of the therapy, thus suggesting that the side toxic effects are not always reversible as it was initially proposed. On the other hand, early detection and prompt therapy of anthracycline associated cardiotoxicity can lead to substantial recovery of cardiac function. On the basis of these observations, we propose to find a new different classification for cardiotoxic side effects of drugs used in cancer therapy.

Keywords: anthracyclines; cancer therapy; cardiotoxicity; immunotherapy; trastuzumab.

MeSH terms

  • Anthracyclines / administration & dosage
  • Anthracyclines / adverse effects
  • Antineoplastic Agents / administration & dosage
  • Antineoplastic Agents / adverse effects*
  • Breast Neoplasms / drug therapy
  • Cardiomyopathies / drug therapy*
  • Cardiomyopathies / etiology
  • Cardiotoxicity / etiology
  • Clinical Trials as Topic
  • Female
  • Heart Failure / etiology
  • Humans
  • Immunotherapy / adverse effects
  • Retrospective Studies
  • Trastuzumab / administration & dosage
  • Trastuzumab / adverse effects*


  • Anthracyclines
  • Antineoplastic Agents
  • Trastuzumab