Levosimendan in Trastuzumab-Induced Cardiotoxicity: A Mechanism-Based Perspective

Trastuzumab is a cornerstone therapy in HER2-positive breast cancer, yet its association with cardiotoxicity remains a major limitation in clinical practice. Trastuzumab-induced cardiac dysfunction, although often considered non-necrotic and potentially reversible, frequently manifests as left ventricular ejection fraction decline and symptomatic heart failure, leading to treatment interruption and compromised oncologic outcomes (1, 2). These clinical challenges highlight the need for a proactive, mechanism-oriented strategy in managing trastuzumab-related cardiac adverse effects.