When should trastuzumab be held or discontinued for cardiac toxicity?

Hold trastuzumab if: LVEF drops ≥10% from baseline AND falls below 50%, OR LVEF drops ≥16% from baseline regardless of absolute value. Recheck LVEF in 4–6 weeks. Resume if LVEF ≥50% and drop from baseline <15%. Permanently discontinue if LVEF fails to improve or symptomatic HF (NYHA III/IV) persists.

How should LVEF be monitored during trastuzumab therapy?

Baseline LVEF required before start. Monitoring every 3 months during treatment (every 6 weeks if borderline). Post-treatment surveillance: every 6 months for 2 years (high-risk patients: prior anthracyclines, cardiac comorbidities). Cardio-oncology consultation for LVEF <50% or symptomatic heart failure.

Trastuzumab Cardiac Monitoring Interval Calculator

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Frequently Asked Questions

When should trastuzumab be held or discontinued for cardiac toxicity?

How should LVEF be monitored during trastuzumab therapy?