Anthracycline, Herceptin, and CV Toxicity

Pervasive late effects limit the utility of radiation and chemotherapy, particularly in the pediatric setting, where treatment at a young age often leads to lifelong morbidity and excess mortality. While advances in the understanding of molecular pathways related to tumorigenesis have led to the development of targeted therapies, recurrent late effects and, as in the case of trastuzumab, unexpectedly high rates of cardiotoxicity highlight gaps in our current 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 with their associated cardiotoxicity. We also describe the cardiac effects of trastuzumab with specific attention to its interaction with anthracyclines.