Key result
Optimal GDMT enables cardiac recovery in asymptomatic LV dysfunction, allowing continued HER2 therapy.
Why the study?
Does guideline-directed medical therapy allow for the safe resumption of HER2-blockade in patients with HER2-positive metastatic breast cancer who develop moderate left ventricular dysfunction?
Case Report (n=1)
Does guideline-directed medical therapy allow for the safe resumption of HER2-blockade in patients with HER2-positive metastatic breast cancer who develop moderate left ventricular dysfunction?
Optimal guideline-directed medical therapy supports cardiac recovery in patients with asymptomatic left ventricular dysfunction, allowing for the safe continuation of HER2-targeted cancer therapy.
BACKGROUND: Permissive cardiotoxicity is increasingly recognized as important in human epidermal growth factor receptor 2 (HER2)-positive breast cancer, where oncologic benefits may outweigh cardiac risks. CASE SUMMARY: A 49-year-old woman with HER2-positive, breast cancer gene 2-mutated metastatic breast cancer developed moderate left ventricular systolic dysfunction (ejection fraction 38%, global longitudinal strain -13.4%) and moderate-to-severe mitral regurgitation 4 months after initiating trastuzumab and pertuzumab. HER2 therapy was temporarily held, and guideline-directed medical therapy (GDMT) was initiated. After partial cardiac recovery, HER2-blockade was resumed under close surveillance. Her left ventricular ejection fraction improved to 52% (global longitudinal strain -17.5%) with GDMT despite continued HER2 therapy. DISCUSSION: The decision to resume HER2 therapy was based on multidisciplinary consensus, incorporating partial cardiac recovery, absence of clinical congestive heart failure, and metastatic disease burden. GDMT enabled the safe resumption of HER2-blockade despite LVEF <40%. TAKE-HOME MESSAGES: Optimal GDMT supports cardiac recovery in patients with asymptomatic left ventricular dysfunction, allowing for continued HER2 therapy. Integrated cardio-oncology care is essential to balance cancer control with cardiovascular safety.
No takes yet. Share an insight, caveat, or question.
Rashid et al. (2026) conducted a case report in HER2-positive metastatic breast cancer with moderate left ventricular dysfunction (n=1). Guideline-directed medical therapy (GDMT) and resumption of HER2-blockade was evaluated on Left ventricular ejection fraction (LVEF) and global longitudinal strain. Guideline-directed medical therapy enabled the safe resumption of HER2-blockade in a patient with metastatic breast cancer, improving left ventricular ejection fraction from 38% to 52%.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: