Cardiac monitoring in HER2-positive patients on trastuzumab treatment: A review and implications for clinical practice
Nathalie I. Bouwer,
Agnes Jager,
Crista Liesting,
Marcel J.M. Kofflard,
Jasper J. Brugts,
Jos J.E.M. Kitzen,
Eric Boersma,
Mark-David Levin
Affiliations
Nathalie I. Bouwer
Department of Cardiology, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3300 AK, Dordrecht, the Netherlands; Department of Internal Medicine, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3300 AK, Dordrecht, the Netherlands
Agnes Jager
Department of Medical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3000 CA, Rotterdam, the Netherlands
Crista Liesting
Department of Cardiology, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3300 AK, Dordrecht, the Netherlands
Marcel J.M. Kofflard
Department of Cardiology, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3300 AK, Dordrecht, the Netherlands
Jasper J. Brugts
Department of Cardiology, Erasmus MC Thoraxcenter, Dr. Molewaterplein 40, 3000 CA, Rotterdam, the Netherlands
Jos J.E.M. Kitzen
Department of Internal Medicine, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3300 AK, Dordrecht, the Netherlands
Eric Boersma
Department of Cardiology, Erasmus MC Thoraxcenter, Dr. Molewaterplein 40, 3000 CA, Rotterdam, the Netherlands
Mark-David Levin
Department of Internal Medicine, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3300 AK, Dordrecht, the Netherlands; Corresponding author.
Trastuzumab prolongs progression-free and overall survival in patients with human epidermal growth factor receptor 2 (HER2) positive breast cancer. However, trastuzumab treatment is hampered by cardiotoxicity, defined as a left ventricular ejection fraction (LVEF) decline with a reported incidence ranging from 3 to 27% depending on variable factors. Early identification of patients at increased risk of trastuzumab-induced myocardial damage is of great importance to prevent deterioration to irreversible cardiotoxicity. Although current cardiac monitoring with multi gated acquisition (MUGA) scanning and/or conventional 2D-echocardiography (2DE) have a high availability, their reproducibility are modest, and more sensitive and reliable techniques are needed such as 3D-echocardiography (3DE) and speckle tracking echocardiography (STE). But which other diagnostic imaging modalities are available for patients before and during trastuzumab treatment? In addition, what is the optimal frequency and duration of cardiac monitoring? At last, which biomarker monitoring strategies are currently available for the identification of cardiotoxicity in patients treated with trastuzumab?
