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Recommendation
Anti-HER2 therapy – Cardiac monitoring
In patients receiving trastuzumab, consider monitoring cardiac function during treatment (e.g. every 3 months) and follow-up. Early referral to a cardiologist should be considered in cases of deterioration in cardiac function.
In patients under trastuzumab, cardiac function should be monitored during treatment (e.g. every 3 months) and during follow-up
Aligned to the current recommendation by the FDA for asymptomatic non-metastatic patients undergoing adjuvant trastuzumab treatment, routine surveillance consisting of cardiac imaging every 3 months should be considered for the early detection of cardiac toxicity. However, the effectiveness of this strategy in patients at low CV risk, with no early evidence of LVD, has not been demonstrated and conversely high-risk patients may require closer monitoring (Level of evidence – II)
The desirable effects of an intervention clearly outweigh the undesirable effects (the intervention is to be put into practice), or the undesirable effects of an intervention clearly outweigh the desirable effects (the intervention is not to be put into practice)
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How this guidance was developed
This recommendation was adapted from the KCE 2013 guidelines (Belgium). The source recommendation was based on a systematic review of the evidence conducted to January 2010 and was graded ‘strong’ (using SIGN methods) by the source guideline authors. The source recommendation was adapted by adding ‘Early referral to a cardiologist should be considered in cases of deterioration in cardiac function’. The additional text in the ESMO (2020) guidelines that ‘the effectiveness of this strategy in patients with low cardiovascular risk and no early evidence of left ventricle dysfunction’ and ‘the closer monitoring of high-risk patients’ is highlighted.
This recommendation is supported by more recent guidelines developed by ESMO (2020) on the management of cardiac disease in cancer patients, although the relevant recommendation indicates that frequency of monitoring may depend on patients’ baseline cardiovascular risk.
Related guidance by topic
Anti-HER2 therapy – Cardiac monitoring
Recommendation
In patients receiving trastuzumab, consider monitoring cardiac function during treatment (e.g. every 3 months) and follow-up. Early referral to a cardiologist should be considered in cases of deterioration in cardiac function.
Principles in action
Multidisciplinary care
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Supportive care
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Care coordination
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This recommendation was adapted from the KCE 2013 guidelines (Belgium). The source recommendation was based on a systematic review of the evidence conducted to January 2010 and was graded ‘strong’ (using SIGN methods) by the source guideline authors. The source recommendation was adapted by adding ‘Early referral to a cardiologist should be considered in cases of deterioration in cardiac function’. The additional text in the ESMO (2020) guidelines that ‘the effectiveness of this strategy in patients with low cardiovascular risk and no early evidence of left ventricle dysfunction’ and ‘the closer monitoring of high-risk patients’ is highlighted.
This recommendation is supported by more recent guidelines developed by ESMO (2020) on the management of cardiac disease in cancer patients, although the relevant recommendation indicates that frequency of monitoring may depend on patients’ baseline cardiovascular risk.
Related guidance by topic
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