Patients receiving HER-2 directed agents are at an increased risk of cardiotoxicity e.g. asymptomatic decrease in the left ventricular ejection fraction (LVEF) and congestive heart failure (CHF).
In patients with a LVEF less than 45% and/or symptomatic heart failure HER-2 directed therapy should be avoided, except in the metastatic setting when breast cancer is life-threatening and where a cardiologist is also involved.
Concurrent anthracycline and HER-2 directed therapy is not recommended for extended periods of time.
Baseline and 3 monthly cardiac function tests are required during treatment. In the metastatic setting, after the first 12 months of therapy, if there are no cardiac complications, the frequency of cardiac assessments may be reduced at the discretion of the treating clinician unless there has been recent exposure to anthracyclines.