epidermal growth factor receptor -2 (HER-2) is a member of EGFR (epidermal
growth factor receptor) family, plays a very significant role in cell growth
and proliferation  HER – 2 protein is over expressed in 20% of breast cancer
and is associated within aggressive course , poor prognosis and response to
treatment [2-3]. The introduction of transtuzumab, a monoclonal antibody
directed against, the extra cellular domain of HER -2 receptor, has
revolutionized the treatment of HER – 2 positive early breast cancer and has
led to significant improvement in disease free survival and overall survival
over chemotherapy alone.
In randomized multicenter
trials with HER – 2 over expressing metastatic breast cancer patients, addition
of transtuzumab to first line chemotherapy has improved objective response
rate, the time to disease progression and overall survival over chemotherapy alone
[4,5]. Hence transtummab is now considered as the standard of care for all
patients who over amplify HER – 2 neu receptors.
These benefits have come
with the cost of increased risk of cardiotoxicity. Transtuzumab related
cardiotoxicity is mediated by interruption of normal HER – 2 signaling pathway
in the heart, which is responsible for maintenance of normal growth, repair and
survival of cardiomyocytes. Cardiotoxicity related to transtuzumab is different
from that of anthracyclins as it is not dose related and appears to be largely
reversible on discontinuation of therapy. There is no alteration is ultra
structural abnormalities where as that due to anthracyclins are caused by free radical
induced oxidative stress to cardiac muscles cells .
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