Anthracyclines/Trastuzumab
This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.
Medical warning:
Serious. These medicines may interact and cause very harmful effects. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.
How the interaction occurs:
Trastuzumab and anthracyclines(daunorubicin, doxorubicin, epirubicin, idarubicin, mitoxantrone) when used separately can cause heart problems. The risk for heart related side effects may be greater when the medicines are used together.
What might happen:
Symptoms could include new or worsening shortness of breath, swelling in the ankles or legs, cough, palpitations, new onset of dizziness or rapid weight gain.
What you should do about this interaction:
Discuss this medication combination with your healthcare professionals (e.g. cancer doctor). They may want to do additional testing or monitoring to help decrease your risk for heart problems. It is important that you do not miss any of these tests. Contact your doctor right away if you have new or worsening shortness of breath, swelling in the ankles or legs, cough, palpitations, new onset of dizziness or rapid weight gain.Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.
References:
1.Herceptin (trastuzumab) prescribing information. Genentech Inc. October 29, 2010.
2.Ellence (epirubicin hydrochloride) US prescribing information. Pharmacia Corporation February, 2013.
3.Curigliano G Cardinale D Suter T etal. Cardiovascular toxicity induced by chemotherapy, targeted agents and radiotherapy: ESMO Clinical Practice Guidelines. Annals of Oncology October, 2012;23(Supplement 7):155-166.
4.Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, . 2009 Focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults. J Am Coll Cardiol 2009 Apr 14;53(15):e1-e90.
5.Yoon GJ, Telli ML, Kao DP, Matsuda KY, Carlson RW, Witteles RM. Left ventricular dysfunction in patients receiving cardiotoxic cancer therapies are clinicians responding optimally?. J Am Coll Cardiol 2010 Nov 9; 56(20):1644-50.
6.Bowles EJ, Wellman R, Feigelson HS, Onitilo AA, Freedman AN, Wagner EH, Pharmacovigilance Study Team. Risk of heart failure in breast cancer patients after anthracycline and trastuzumab treatment: a retrospective cohort study. J Natl Cancer Inst 2012 Sep 5;104(17):1293-305.
7.Carlson RW, Allred DC, Anderson BO, Burstein HJ, etal. Metastatic breast cancer, version 1.2012: featured updates to the NCCN guidelines. J Natl Compr Canc Netw 2012 Jul 1;10(7):821-9.
8.Chen J, Long JB, Hurria A, Owusu C, Steingart RM, Gross CP. Incidence of Heart Failure or Cardiomyopathy After Adjuvant Trastuzumab Therapy for Breast Cancer. J Am Coll Cardiol 2012 Nov 2.
