Common Trastuzumab Side Effects

Common trastuzumab side effects include:
- Flu-like symptoms:
  - Fever
  - Chills
  - Mild pain
  - Nausea
  - Diarrhea
However:
- The more serious adverse event is:
  - Cardiotoxicity
Cardiac dysfunction:
- Occurs in 2% to 7% of patients and includes:
  - Congestive heart failure
As a result:
- Regular screening of cardiac ejection fraction:
  - Is warranted during treatment
- Luckily the decline in ejection fraction:
  - Appears to be reversible with:
    - Cessation of the medication and standard therapies used to treat congestive heart failure
The risk of cardiotoxicity is increased:
- When combined with anthracycline-based chemotherapy regimens:
  - A retrospective review of seven phase II and III trastuzumab clinical trials:
    - Found the incidence of cardiac dysfunction was:
      - 27%:
        In patients receiving trastuzumab and anthracycline plus cyclophosphamide chemotherapy
    - Was substantially lower at 13% in patients receiving paclitaxel and trastuzumab
    - Was lowest if receiving trastuzumab alone:
      - 3% to 7%
        However:
        Most of these patients had received prior anthracycline therapy
        Nonetheless, the use of trastuzumab remains justified given its significant impact on overall survival

REFERENCES

Seidman A1, Hudis C, Pierri MK, et al. Cardiac dysfunction in the trastuzumab clinical trials experience. J Clin Oncol. 2002;20(5):1215-1221.
Breast Cancer Care. Trastuzumab (Herceptin). https://www.breastcancercare.org.uk/information-support/facing-breast-cancer/going-through-treatment-breast-cancer/targeted-therapy/trastuzumab-herceptin Published July 2016. Accessed January 31, 2017.

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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO