Trastuzumab can reduce left ventricular function, usually reversibly, and the risk is higher after anthracyclines, in older patients and with pre-existing cardiac disease or hypertension.
Measure ejection fraction before starting and periodically during treatment, commonly every three months. A significant fall usually means pausing HER2 therapy and involving cardiology; many patients recover and can resume. Control blood pressure and other cardiovascular risk factors throughout.
- Check ejection fraction before starting trastuzumab
- Repeat it at regular intervals during treatment, commonly every three months
- Pause HER2 therapy and involve cardiology for a significant fall
- Control blood pressure and cardiovascular risk factors throughout
Why it matters
Most trastuzumab cardiotoxicity is reversible when caught early.
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