Can Herceptin be continued in patients who experience cardiotoxicity?
• A: The safety of continuation or resumption of Herceptin in patients who experience Herceptin-induced left ventricular cardiac dysfunction has not been studied. Patients should undergo monitoring for decreased left ventricular function before Herceptin treatment, and frequently during and after Herceptin treatment. In patients with asymptomatic declines in LVEF, Herceptin may be held and resumed up to 3 times using the guidelines below (Herceptin PI, May 2008). Withhold Herceptin dosing for at least 4 weeks for either of the following: • ≥16% absolute decrease in LVEF from pretreatment values • LVEF below institutional limits of normal and ≥10% absolute decrease in LVEF from pretreatment values. • Herceptin may be resumed if, within 4 to 8 weeks, the LVEF returns to normal limits and the absolute decrease from baseline is ≤15%. • Permanently discontinue Herceptin for a persistent LVEF decline (>8 weeks) or for suspension of Herceptin dosing on more than three occasions for cardiomyop
