Time to Personalize Surveillance for Cancer Therapy-Related Cardiac Dysfunction in HER2-Targeted Therapy: One Size...

Area of Science:

• Cardio-oncology
• Cardiovascular Medicine
• Oncology

Background:

• Cancer therapy-related cardiac dysfunction (CTRCD) poses a significant risk.
• Current cardiac surveillance is often intensive and uniform, neglecting individual cardiotoxicity risk.
• HER2-targeted therapy exemplifies the need for personalized monitoring.

Purpose of the Study:

• To review the rationale for transitioning from blanket cardiac surveillance to risk-based, personalized monitoring strategies.
• To evaluate the safety and efficacy of individualized monitoring in cancer patients.
• To discuss the application of risk-adapted strategies for various cardiotoxic therapies.

Main Methods:

• Review of evolving definitions and risk stratification tools for CTRCD.
• Analysis of prospective studies on reduced-frequency echocardiographic surveillance in low-risk patients.
• Evaluation of evidence for other cardiotoxic agents like BRAF/MEK and VEGF inhibitors.

Main Results:

• Substantial heterogeneity in cardiotoxicity risk is evident.
• Reduced echocardiographic surveillance appears safe for low-risk patients on non-anthracycline HER2-targeted therapies.
• Cardiovascular and oncologic outcomes are not compromised in these patients.

Conclusions:

• Risk-adapted cardiac surveillance is a pragmatic, evidence-based approach.
• It optimizes resource utilization while ensuring patient safety.
• Prospective validation and guideline harmonization are needed for personalized cardio-oncology care.