top of page

HER2 inhibitors
(e.g., trastuzumab, pertuzumab, margetuximab, lapatinib, naratinib, tucatinib)

Cardio-oncological evaluation*, BNP or NT-proBNP and Troponin**

before cancer treatment begins

  • In patients with LVEF <40%, anti-HER-2 are not recommended unless there are no effective alternative cancer treatment options.

  • In patients with LVEF <50% but ≥40%, ACEi (or ARB) and/or BB are recommended before treatment.

  • In patients exposed to multiple cardiotoxic agents with a normal LVEF and cardiovascular risk factors, ACEi (or ARB) and/or BB may be considered.

Presence of any of the following risk factors:

age ≥ 65, mediastinal radiotherapy, previous heart disease, previous cardiotoxic drugs,  ≥two risk factors (including smoking, hypertension, diabetes, dyslipidemia, chronic renal insufficiency, and obesity), baseline elevation of cardiac biomarkers, previous cardiotoxic drugs

yes

Cardio-oncological evaluation*

every 3 months during treatment

AND

Troponin**

after each cycle (end of infusion)

no

Cardio-oncological evaluation*

every 3 months during treatment

CV symptoms/signs OR Troponin +

yes

Cardio-oncological evaluation*

before the next cycle and tailored monitoring on case-by-case basis

no

Annual cardiovascular risk assessment
and
Cardio-oncological evaluation*
within the year after the end of cancer treatment, at years 1, 3, 5, and every 5 years thereafter

* A cardio-oncological evaluation will systematically include at least one visit with blood pressure, blood glucose, lipid profile, GFR calculation, ECG and trans-thoracic echocardiography (TTE). Measurements of global longitudinal strain and 3D LVEF (if feasible) are recommended with the same machine.

**Assays should be carried out by the same laboratory (same type of troponin, same method of measurement).

Troponin + if >99e percentile of the URL

​

ACE=angiotensin converting-enzyme inhibitor; ARB=angiotensin receptor blocker; BB=beta-blocker; LVEF=left ventricular ejection fraction

bottom of page