HER2 inhibitors

(e.g., trastuzumab, pertuzumab, lapatinib)

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 factors:

age ≥ 60, mediastinal radiotherapy, previous heart disease, ≥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

Cardio-oncological evaluation*

at the end of cancer treatment and at 6 months, 1 year, 2 years, and periodically thereafter if prior anthracyclines

* 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

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Centre Méditerranéen Hospitalo-Universitaire de Cardio-Oncologie

​Hôpital Nord, chemin des Bourrely, 13015 Marseille, France

Aix-Marseille Université

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