Herceptin side-effects

[judy]

I have been on Herceptin for 9 months. My MUGA scans have all been very, very strong relative to left ventricle -- currently at 86. However, I have had severe & increasing shortness of breath and, on review, it was discovered that my RIGHT ventricle #s had been decreasing consistently. Now, my RV ejection fraction is 29.

Does anyone have any knowledge of Herceptin causing RIGHT ventricle problems. I have not been able to locate any anecdotal or scientific data relating to this.

I would appreciate any feedback.

Thanks so much

Judy

Dr. Slamon quotes a study which shows that herceptin, especially in combination with anthracyclines causes dilative cardiomyopathy (that involves both sides of the heart) and is related to mitochondrial dysfunction and vacuolization of the heart muscle(holes form within the substance of the muscle cells) itself. There is a whole body of literature on herceptin's effects on the heart. Just use either Google or PubMed and put in heart and Herceptin. The truth, as usual, is that there is a lot more that isn't known than is known. But it IS an area of active interest.

Hope this helps!
Lani

[judy]

Lani:

Thanks for the quick response. I used both Google and PubMed. While I saw many items addressing left ventricle issues, I still did not see any citations suggesting right ventricle problems. I would appreciate it if you could give me a specific site citation that I can access.

Thanks again.

Juidy

I do not believe the literature addresses Herceptin causing problems with only one part or side of the heart--as I believe they are feeling the problem caused by herceptin is a GLOBAL one, affecting ALL parts of the heart made up of smooth muscle cells (all).They usually call it dilative cardiomyopathy. Although Herceptin appears to be involved in embryology of development of specific parts of the heart (trabeculae, electrical conduction system to some extent) in the adult the problems do not seem to be with one part of the heart (as it would be if the effect were electrical, mechanical or "plumbing" for example lack of contraction of just one of four chambers due to lack of blood supply to the electrical pathway going to that area, or lack of contraction of just one area of one chamber as might happen after a heart attack due to death of muscle cells in one area leaving just scar which cannot contract or narrowing of the arteries leaving the right side of the heart to go to the lungs which would cause the right side of the heart to back up (like a clogged rain gutter). Since herceptin seems to affect the subcellular organelles which produce energy in the smooth muscle cells that the entire heart is made out of the only difference in which chambers/side dilate(stretch out like a bathing suit which has been in the Jacuzzi too many times)and do not contract well probably has to do with which ones have to pump against gravity (ventricles) and how badly the next chamber on is backing up.

I believe Robin P is an ex cardiac ICU nurse from Johns Hopkins. Perhaps she could address this better than I can.

If your left ventricular ejection fraction is OK and your right one isn't, perhaps you have a second problem with your pulmonary vasculature
or the electricity, plumbing or mechanics of the right side of your heart.

A few teaching hospitals (Stanford among them) have 3 dimensional echo cardiograms(the ones commonly in use are 2d). They have not yet learned to charge differently for them so they do not use them routinely. If your cardiologist cannot figure out why the right side of your heart is differentially affected, perhaps he/she can refer you for one.

Again, maybe herceptin has some other effect we do not know about yet, or that I missed in my review of the Herceptin and heart problems literature in early December.

There is so much that is not known.

I am certainly no cardiologist!

Robin, any input?

[Lolly]

Judy, I found this study which may answer some of your questions, but the conclusion is that really not much is known about how Herceptin damages the heart. Lolly


Influence of trastuzumab on epirubicin pharmacokinetics in metastatic breast cancer patients
http://annonc.oxfordjournals.org/cgi...full/14/8/1222



"...The mechanism by which trastuzumab treatment leads to an increased incidence of cardiac dysfunction in patients treated with anthracyclines has not yet been defined. A strong expression of HER2 receptors was not observed in the tissue obtained from heart biopsies from 60 patients with cardiac dysfunction, nor from 25 breast cancer patients with or without previous anthracycline treatment [17]. Nonetheless, cardiotoxicity seems to be related to myocardial uptake of trastuzumab [18]. In fact, it was observed that, in a group of 20 patients, seven had myocardial uptake of radiolabeled trastuzumab. Six out of the seven patients developed cardiotoxicity, and the seventh had episodes of cardiac arrhythmia during the administration of trastuzumab. In the 13 patients without myocardial uptake, no adverse cardiac effect occurred. Recent animal studies have demonstrated that in ErbB2-deficient conditional mutant mice there is a progressive onset of multiple independent parameters of dilated cardiomyopathy, the same type of cardiac dysfunction evident in patients treated with trastuzumab [5, 19], and that ErbB2-deficient cardiomyocytes are more susceptible to anthracycline-induced cell death [5]...."

[judy]

Lolly:

Thanks so much for the citation. I will read the article. I appreciate your help.

Judy

[Nickii]

I had IDC with 1 out of 13 nodes positive. Had bil. mastectomy and just recently finished chemo. 4 rounds of a/c and 4 rounds of taxotere with herceptin. I am er/pr neg and her2 Positive. After 12 rounds of herceptin my muga scan showed an ejection of 48. I stopped the herceptin for one month. Had a repeat muga scan and the ejection fraction went up to 62. I see my onc this coming Monday. I don't know if I want to go back on the Herceptin. I am feeling so good right now. Big decision! Husband doesnt want me to go back because I was so sick.

Nickii

[Pam Bellendir]

Hello,

I am needing information from you ladies. I am on Herceptin (since Sept. 05) have just found out my heart is slightly enlarged. I have been having shortness of breath and am wondering if any of you have had an enlarged heart with shortness of breath (this is even why I had a chest x-ray)? Dr. halted herceptin the past two weeks till I see the cardiologist. Thanks for any input.

[Cathya]

Pam;

Are you an atheletic....long distance runner type? I know that sometimes these atheletes have enlarged hearts.

Cathya

[Pam Bellendir]

Thanks for responding. No I am not an atheletic person. I do however try to walk aggressively. I am not out of shape for a 46yo. But am in a house we are remodeling and moved to this area of KY before starting chemo. I had shortness of breath while on chemo. Was told it was probably just due to steroids. So, I wrote it off. I was in Florida for a week, last week and after the first night, I had no shortness of breath until I came back home. It started the first morning I was home. Told the doctor about this and still that doesn't explain the enlarged heart. Just a possibility of asthma or allergies. Will see cardiologist today. I can't find any allergens causing a heart to enlarge. So still just hoping it isn't the Herceptin, but it may be. Thanks again.