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Trastuzumab Cardiotoxicity — RACP Adult Medicine MCQ

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EasyMedical OncologyTrastuzumab CardiotoxicityRACP Adult Medicine

A 58-year-old woman with metastatic HER2-positive breast cancer is commenced on trastuzumab plus pertuzumab with docetaxel. What cardiac monitoring is required?

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Correct answer: B — Baseline and 3-monthly echocardiography or MUGA scan

Trastuzumab causes cardiotoxicity (LVEF decline) in 4–7% of patients as monotherapy and higher when combined with anthracyclines. Baseline LVEF assessment followed by 3-monthly echocardiography or MUGA is mandated. Trastuzumab should be withheld if LVEF falls >10% to below 50% and permanently discontinued if LVEF falls >16% from baseline or below 39%. Unlike anthracycline toxicity, trastuzumab cardiotoxicity is usually reversible.

Reference: Cancer Council Australia – 2024 – Breast Cancer Guidelines; ESC – 2022 – Cardio-Oncology Guidelines