Risk Stratification for Trastuzumab-Induced Cardiac Dysfunction and Potential Implications for Surveillance

Area of Science:

• Cardio-oncology
• Oncology
• Cardiology

Background:

• Cancer therapy-related cardiac dysfunction (CTRCD) is a risk during HER2-directed therapy.
• Frequent left ventricular ejection fraction (LVEF) monitoring is standard, regardless of patient risk.
• Patient factors and anthracycline use influence CTRCD risk.

Purpose of the Study:

• To evaluate the incidence of trastuzumab-associated CTRCD in HER2-positive breast cancer patients.
• To assess a risk assessment tool for identifying low-risk patients for CTRCD.
• To guide personalized, risk-based surveillance strategies for cardiac function.

Main Methods:

• Retrospective cohort study of 496 patients with HER2-positive breast cancer treated with trastuzumab.
• Patients categorized into low, medium, and high/very high risk groups using a validated risk assessment tool.
• Median follow-up of 51 months to assess CTRCD and heart failure (HF) incidence.

Main Results:

• 8.7% of patients developed CTRCD, with 1.6% experiencing heart failure (HF).
• CTRCD rates varied by risk group: 3.6% (low), 12.8% (medium), 32.1% (high/very high).
• The risk assessment tool demonstrated a 96.4% negative predictive value for CTRCD in low-risk patients.

Conclusions:

• Findings support personalized, risk-based LVEF surveillance during trastuzumab therapy.
• Less frequent monitoring for low-risk patients may optimize resource use and reduce patient burden.
• A risk-based approach may maintain safety while improving efficiency of cardiac monitoring.