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Invited Commentary
August 2016

Cardiac Protection in HER2-Targeted Treatment: How Should We Measure New Strategies?

Author Affiliations
  • 1MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC
  • 2Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC
JAMA Oncol. 2016;2(8):1037-1039. doi:10.1001/jamaoncol.2016.0283

Therapies targeted at human endothelial growth factor receptor 2 (HER2) have revolutionized the treatment of HER2-positive breast cancer and continue to improve survival of patients with early and metastatic breast cancer. Cardiac dysfunction, either as asymptomatic decline of the left ventricular (LV) ejection fraction (LVEF) or symptomatic heart failure (HF), represents the main adverse effect that has limited the use of HER2-targeted agents. Current clinical recommendations include LV function assessment prior to initiation of trastuzumab therapy, routine LVEF monitoring every 3 months during treatment, and discontinuation of trastuzumab based on the changes in LVEF. These recommendations are largely based on the design of adjuvant trastuzumab trials in early breast cancer that documented few symptomatic HF events, which occurred largely in patients with anthracycline exposure. At the same time, continued evidence of significant benefits of trastuzumab in improving outcomes of patients with HER2-positive breast cancer raises significant concerns about the interruptions of trastuzumab treatment1 and highlights the need for strategies that will allow continued administration of HER2 therapy.