CORRESPONDENCEWe read with great interest the Review by Ewer, M. S. & Ewer, S. M. (Cardiotoxicity of anticancer treatments. Nat. Rev. Cardiol. 12, 547-558;2015), 1 because it is highly relevant to our research. We appreciate the thorough review of the heart disorders and the associated molecular mechanisms elicited by receptor tyrosine-protein kinase erbB-2 (ERBB2)-targeted agents in this article. However, we believe that the authors' description of trastuzumab as "the first mono clonal antibody tyrosine kinase inhibitor" is conceptually incorrect and does not reflect the current state of literature in this field.Tyrosine kinase inhibitors (TKIs), such as lapatinib, inhibit the kinase activity of epidermal growth factor receptor (EGFR), and ERBB2 and ligand-induced receptor phosphorylation by reversibly binding to the ATP-binding site of the kinase. 2 Cetuximab, a therapeutic monoclonal antibody directed against the extracellular domain of EGFR, acts as a TKI to block the activation of EGFR tyrosine kinase by competing for ligand binding. 3,4 Trastuzumab is a therapeutic monoclonal antibody directed against the extracellular domain of ERBB2. 5 However, the effects of trastuzumab on ERBB2 kinase activity are different from those of TKIs and cetuximab. An anti-ERBB2 mono clonal antibody 4D5, which was later humanized to generate trastuzumab, was shown to exhibit agonistic signalling, resulting in increased ERBB2 phosphorylation that correlated with its inhibitory effect on ERBB2-overexpressing breast cancer cells. 6 Growing evidence indicates that targeting ERBB2 using trastuzumab increases ERBB2 tyrosine phosphorylation in trastuzumab-sensitive breast cancer cells. 7-9 Diemeier and colleagues reported that the inhibitory effect of trastuzumab on trastuzumab-sensitive breast