Cardiac Safety of Reduced Cardiotoxicity Surveillance During HER2-Targeted Therapy

Area of Science:

• Cardiology
• Oncology
• Pharmacology

Background:

• Echocardiograms are standard every 3 months for cancer therapy-related cardiac dysfunction (CTRCD) monitoring in HER2-targeted therapy.
• Safer HER2-targeted regimens have reduced CTRCD risk, questioning the necessity of intensive monitoring.

Purpose of the Study:

• To evaluate the cardiac safety of reduced CTRCD surveillance (every 6 months) during non-anthracycline HER2-targeted treatment.
• To assess the feasibility of a less frequent echocardiogram schedule.

Main Methods:

• A non-randomized clinical trial included 190 HER2-positive breast cancer patients on non-anthracycline HER2-targeted therapy.
• Echocardiograms were performed every 6 months; exclusion criteria included prior anthracycline use and cardiovascular disease.
• Primary outcome was cardiac events (heart failure, cardiovascular death) at 1 year.

Main Results:

• No cardiac events occurred in 190 patients over a median 17.5-month follow-up (0%; 97.5% CI: 0%-1.9%).
• One patient (0.5%) developed asymptomatic CTRCD, resuming treatment after interruption.
• Adherence to the 6-month surveillance schedule was 73.2% (intention-to-treat).

Conclusions:

• Reduced CTRCD surveillance every 6 months is safe and feasible for low-risk patients.
• This strategy may be appropriate for HER2-targeted treatment regimens not involving anthracyclines.