Severe Reversible Cardiotoxicity in a Breast Cancer Patient Without Cardiovascular Risk Factors

Introduction: Although it is known that cardiotoxicity complicates more than 30 % of breast cancer cases, its reversibility is still in question. We report a case of trastuzumab-induced cardiotoxicity in a patient without cardiovascular risk factors and with normal cardiac function before chemotherapy.
Case presentation: A 39-year-old Caucasian woman diagnosed with T4N2M1 breast cancer and osteolytic bone metastasis underwent chemotherapy with trastuzumab-docetaxel-doxorubicin. Before treatment, the echocardiography showed normal systolic function with left ventricular ejection fraction (LVEF) of 66 %. Initially she received doxorubicin 48 mg/m²/day and docetaxel 125 mg/m², every 21-30 days for a total of 8 cycles, followed by 330 mg/cycle of trastuzumab (cycles 9-13) and 375 mg/cycle for the next 5 cycles After nine months of treatment with trastuzumab, on the 18th regimen of chemotherapy, the patient developed decompensated heart failure manifested by dyspnea, orthopnea, fatigue, palpitations, pallor and peripheral edema. Electrocardiography showed intermediate heart axis, regular sinus tachycardia 130 bmp and ventricular extrasystoles. Echocardiography revealed impaired systolic function LVEF of 42 % and left ventricular global akinesia. 2D strain imaging revealed longitudinal and segmental myocardial deformation. Trastuzumab-induced cardiotoxicity was suspected and treatment for congestive heart failure was initiated. The patient’s symptoms receded and she was discharged with a LEVF of 48%. After 6 months, cardiac magnetic resonance imaging showed normal cardiac function with a LEVF of 57 %.
Conclusions: This data suggest that trastuzumab-induced cardiotoxicity might be reversible, but response is dependent on early detection and prompt intervention. Close communication between oncologists and cardiologists is required.