Anthracyclines, Trastuzumab, and Cardiovascular Toxicity

The pervasive late effects of radiation and chemotherapy significant limit their utility as cancer treatments, especially in children, where such treatments often result in lifelong morbidity and excess mortality. Advances in the understanding of molecular pathways related to tumorigenesis have enabled the development of targeted therapies. However, recurrent late effects, such as those associated with trastuzumab, along with unexpectedly high rates of cardiotoxicity underscore critical gaps in our understanding of drug pathways and the mechanisms of treatment toxicity. This review examines the mechanisms of anthracycline activity in tumor and cardiac cells, the clinical manifestations of their associated cardiotoxicity, prevention strategies, and monitoring recommendations. Additionally, we explore the cardiac effects of trastuzumab with specific attention to its interaction with anthracyclines.