Anticancer drugs: trastuzumab cardiotoxicity: practice question

A Pharmacology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pharmacology · Anticancer drugs: trastuzumab cardiotoxicity

Sample item

A woman with HER2-positive breast cancer treated with doxorubicin and cyclophosphamide is receiving trastuzumab. A routine echocardiogram shows left ventricular ejection fraction fallen from 62 to 45 percent, and she is asymptomatic. What is the most appropriate management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Withhold trastuzumab, start cardiac therapy and repeat echocardiography after a few weeks

Trastuzumab-related cardiac dysfunction is not strictly cumulative-dose dependent and is often reversible, but risk is increased after anthracyclines. A fall in ejection fraction to below normal with a drop of 10 points or more means holding the drug, starting heart failure therapy and repeating imaging, with possible re-challenge on recovery. Monitoring is performed regularly during therapy.

Option by option

  • A. Withhold trastuzumab, start cardiac therapy and repeat echocardiography after a few weeks (correct)

    Correct. Holding therapy and treating cardiac dysfunction allows recovery in many patients.

  • B. Switch trastuzumab to a higher-dose anthracycline

    Another anthracycline would be cardiotoxic and is the wrong choice in this setting.

  • C. Continue trastuzumab and add dexrazoxane

    Dexrazoxane is not the answer for trastuzumab-related dysfunction, and continuing the drug risks heart failure.

  • D. Stop all anti-HER2 therapy permanently as the damage is always irreversible

    Trastuzumab cardiotoxicity is frequently reversible, unlike anthracycline damage, so permanent cessation is not automatic.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is A, Withhold trastuzumab, start cardiac therapy and repeat echocardiography after a few weeks. Trastuzumab-related cardiac dysfunction is not strictly cumulative-dose dependent and is often reversible, but risk is increased after anthracyclines.

Why is "Switch trastuzumab to a higher-dose anthracycline" not the answer?

Another anthracycline would be cardiotoxic and is the wrong choice in this setting.

Why is "Continue trastuzumab and add dexrazoxane" not the answer?

Dexrazoxane is not the answer for trastuzumab-related dysfunction, and continuing the drug risks heart failure.

Why is "Stop all anti-HER2 therapy permanently as the damage is always irreve…" not the answer?

Trastuzumab cardiotoxicity is frequently reversible, unlike anthracycline damage, so permanent cessation is not automatic.

What concept does this question test?

It tests Anticancer drugs: trastuzumab cardiotoxicity in Pharmacology. A fall in ejection fraction to below normal with a drop of 10 points or more means holding the drug, starting heart failure therapy and repeating imaging, with possible re-challenge on recovery. Monitoring is performed regularly during therapy.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Anticancer drugs: trastuzumab cardiotoxicity?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.