HER2-targeted antibodies can cause left ventricular dysfunction, usually reversible, and the risk is higher after anthracyclines, in older patients and in those with existing heart disease or hypertension.
Measure ejection fraction by echocardiography or MUGA before starting, and repeat it at regular intervals during treatment according to local protocol. A significant fall calls for interrupting therapy and involving cardio-oncology, not simply continuing.
Ask about breathlessness, oedema and reduced exercise tolerance at every visit, since symptoms can precede the next scheduled scan.
- Baseline ejection fraction before any HER2-targeted antibody
- Repeat at regular intervals during treatment
- Interrupt therapy and seek cardiology input after a significant fall
- Ask about heart-failure symptoms at every visit
Why it matters
Cardiotoxicity is usually reversible when caught early.
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