Key points
- Before cardiotoxic treatment: baseline risk (age, heart disease, risk factors, previous treatment), ECG, echo with GLS and troponin/NT-proBNP [1].
- Anti-HER2 treatment: echo every 3 months during treatment [1].
- A moderate asymptomatic fall in ejection fraction usually means continuing treatment with a cardiac drug and closer monitoring, not automatic interruption [1].
- Immunotherapy myocarditis is rare but fatal: baseline troponin [1].
Monitoring plan
| Treatment | Before treatment | During and after treatment |
|---|---|---|
| Anthracyclines | Echo, troponin and NT-proBNP | Echo at the end of treatment and 12 months later; at high risk, before later cycles (and after a cumulative dose of 250 mg/m²) [2] |
| Trastuzumab and other anti-HER2 drugs | Echo | Every 3 months and 12 months after completion |
| Checkpoint inhibitors | ECG and troponin | Troponin before doses 2 to 4 in high-risk patients; with symptoms: troponin, ECG, echo and cardiac MRI |
| VEGF inhibitors | Blood pressure | Weekly blood pressure in the first month |
| Fluoropyrimidines | Assessment for coronary artery disease | Chest pain during the infusion: stop the drug and do an ECG (coronary spasm) |
A falling ejection fraction with anti-HER2 treatment
- Mild (ejection fraction 50% or more with a fall in GLS or a rise in biomarkers): continue; consider an ACE inhibitor/ARB or a beta-blocker [1].
- Moderate (40 to 49% with a fall of 10 points or more): continue with a cardiac drug and closer monitoring, after cardiology advice [1].
- Severe (below 40%) or symptomatic heart failure: pause treatment and treat the heart failure [1].
Raised troponin with an abnormal ECG or echo, especially with myositis or myasthenia: stop immunotherapy and give methylprednisolone 500 to 1000 mg daily for 3 to 5 days [1].
Related tools: cumulative anthracycline dose · QTc
References
2 referencesShow all references, 1 with a study cardClose the reference list
Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.
- 1
- 2Prevention and Monitoring of Cardiac Dysfunction in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline
This page is based on reputable scientific sources and was last updated on 28 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.
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