How often are echocardiograms (echos) repeated on Trastuzumab (trastuzumab)?

From the Guidelines

Echocardiograms (echos) for patients on trastuzumab should be performed every 3 months during treatment, as recommended by the most recent guidelines 1. This monitoring schedule is essential because trastuzumab can cause cardiotoxicity, specifically a decrease in left ventricular ejection fraction (LVEF) that may lead to heart failure. Patients should have a baseline echo before starting treatment, followed by regular assessments throughout therapy. If cardiac function remains stable, some protocols may allow extending the interval to every 4 months, but the standard recommendation is quarterly monitoring, as supported by earlier guidelines 1. Key considerations for monitoring include:

• Baseline assessment of cardiac function before starting trastuzumab
• Regular monitoring (every 3 months) during treatment to detect early signs of cardiotoxicity
• Adjusting the monitoring schedule based on individual patient risk factors and cardiac function
• Considering cardioprotective treatments if LVEF decreases or shows signs of cardiac dysfunction, as outlined in the latest consensus recommendations 1
• Potential continuation of trastuzumab therapy with mild asymptomatic reductions in LVEF, under close cardiac monitoring. After completing trastuzumab therapy, follow-up echos are typically recommended at 6 and 12 months to monitor for delayed cardiotoxicity, aligning with the goal of balancing oncologic benefits with cardiac safety.

From the FDA Drug Label

The following schedule is recommended: Baseline LVEF measurement immediately prior to initiation of Ogivri LVEF measurements every 3 months during and upon completion of Ogivri Repeat LVEF measurement at 4 week intervals if Ogivri is withheld for significant left ventricular cardiac dysfunction LVEF measurements every 6 months for at least 2 years following completion of Ogivri as a component of adjuvant therapy.

The echocardiograms (echos) are repeated on Trastuzumab (trastuzumab) as follows:

• Baseline: immediately prior to initiation of Ogivri
• Every 3 months: during and upon completion of Ogivri
• Every 4 weeks: if Ogivri is withheld for significant left ventricular cardiac dysfunction
• Every 6 months: for at least 2 years following completion of Ogivri as a component of adjuvant therapy 2

From the Research

Echocardiogram Frequency on Trastuzumab

• Echocardiograms are repeated at various intervals for patients on Trastuzumab, with the goal of monitoring cardiac function and detecting potential cardiotoxicity.
• According to the study 3, echocardiographic surveillance is recommended every 3 months in patients undergoing Trastuzumab treatment, irrespective of the baseline cardiotoxicity risk.
• In the study 4, patients had baseline and 3-6 months and 12-15 months of follow-up echocardiograms after initiation of Trastuzumab therapy.
• The study 5 had patients undergo echocardiograms at the beginning of Trastuzumab treatment and every 3 months during the first year.
• The study 6 had patients undergo echocardiography prior to Trastuzumab therapy initiation at baseline, 3- and 6-months post Trastuzumab therapy.
• The study 7 evaluated patients with 6 echocardiograms over 14 months, with assessments at baseline and at various time points after starting chemotherapy.

Timing of Echocardiograms

• The optimal timing for detecting cardiotoxicity by means of imaging parameters (such as LVESV and GLS) is 1 month after completion of anthracycline treatment, as found in the study 7.
• The study 3 found that all cancer therapy-related cardiac dysfunction (CTRCD) occurred sporadically during the first 9 months of the active Trastuzumab regimen.
• The study 5 found a decrease in left ventricular ejection fraction between the first and fourth exams, with exams spaced 3 months apart.
• The study 6 found significant upregulation of biomarkers and circulating miRNAs at 3- and 6-months post Trastuzumab therapy, indicating potential cardiotoxicity.