Medical Oncologist
Monitoring on Herceptin
Tests and Monitoring — While You Are on Trastuzumab
Trastuzumab affects your heart as well as the cancer. Your team schedules specific tests at set points to catch any change early — and to keep your treatment on track.
Medically reviewed by Dr. T. Raghavender Reddy, Medical Oncologist, MBBS · DM (Medical Oncology) · MD (Radiation Oncology) · Last reviewed August 2026
- Heart scans are the priority — Trastuzumab can affect how well your heart pumps, so scans are done at regular intervals throughout treatment.
- Most changes are reversible — When heart function changes are caught at routine monitoring, they can usually be managed without permanent harm.
- Blood tests run alongside — Your team also checks blood counts and organ function before each treatment or at set intervals.
- Attend even when you feel well — Monitoring catches changes before symptoms appear. Missing a scan or test means missing the safety check.
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Trastuzumab monitoring centres on your heart function. Your team scans your heart at baseline and at intervals during treatment, and checks your blood regularly. These tests exist to catch any change while it is still manageable. NCCN and ASCO both recommend this monitoring schedule as a standard part of trastuzumab treatment.
What happens at each stage of monitoring?
Before your first dose
Your team does a baseline heart scan — usually an echocardiogram or MUGA scan — and blood tests. This gives them a starting point to measure against throughout treatment.
Before each treatment cycle
Blood tests check your counts before trastuzumab is given. Your team also asks about any new symptoms at this point.
At interval heart scans
Heart scans are repeated at set points during treatment, as recommended by NCCN and ASCO. How often depends on your specific regimen and whether any earlier result raised a concern.
If a result changes
Your oncologist reviews the result and decides whether to continue, pause or adjust treatment. Most changes that are caught at monitoring are manageable.
At the end of treatment
A final scan confirms how your heart has responded over the full course. Your team will tell you whether ongoing checks are needed after treatment ends.
What you should do to help monitoring work
- Attend every scheduled heart scan, even if you feel completely well.
- Tell your team about breathlessness, ankle swelling, unusual fatigue or chest tightness.
- Bring a full list of all medicines, supplements and herbal remedies to each visit.
- Tell your team if you have a history of heart disease or high blood pressure.
- Ask your team when your next scan is due if you are not sure.
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Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
Surgical Oncologist
Surgical Oncologist
Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
Surgical Oncologist
Radiation Oncologist
Radiation Oncologist
Radiation Oncologist
Hematologist
Interventional Radiologist
Dr. Mohammed Imran
Surgical Oncologist
Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
Surgical Oncologist
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What does each test check, and what happens if the result changes?
| Test | When done | What it measures | If the result changes |
|---|---|---|---|
| Echocardiogram or MUGA scan | Baseline, then at set intervals | How strongly your heart pumps (ejection fraction) | Treatment may be paused or stopped; most cardiac changes are reversible |
| Full blood count | Before each cycle or periodically | Red cells, white cells, and platelets | Timing of next dose may be adjusted; rarely a reason to stop trastuzumab |
| Liver function tests | Periodically during treatment | How your liver is handling treatment | Team reviews any rise; rarely significant with trastuzumab alone |
| Clinical assessment | Every visit | Symptoms of infusion reaction or heart failure | Reported symptoms may bring the next scan forward |
| Typically starts | Before dose one | Baseline values to compare against | All later results are measured against your own starting point, not a population average |
Did you know?
Cardiac effects from trastuzumab are usually reversible when they are caught at routine monitoring.
The schedule exists precisely because early detection changes the outcome — which is why attending scans when you feel well matters as much as reporting symptoms.
Source: NCCN Guidelines: HER2-Positive Breast Cancer and Cardiotoxicity Management
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Common questions
Frequently asked questions
Why does trastuzumab affect the heart?
Trastuzumab targets HER2, a protein found on some cancer cells. HER2 is also present in heart muscle cells, and blocking it can affect how well the heart pumps. This is not the same mechanism as chemotherapy-related heart damage, and in most cases the effect is reversible if caught at monitoring. The risk is real but manageable, which is why the monitoring schedule is built into the treatment plan from the start.
What happens if my heart scan shows a change?
Your oncologist will review the result and decide next steps. In many cases trastuzumab is paused while the heart recovers, and the drug is restarted once function returns. In some cases treatment is stopped permanently. The decision depends on how much the result has changed and how the cancer is responding. Catching the change at a routine scan — before symptoms appear — is what keeps the most options open.
How often will I need a heart scan?
The interval is set by your oncologist based on your regimen and any earlier results that raised concern. NCCN and ASCO guidance recommends regular monitoring throughout trastuzumab treatment rather than a single check. Ask your team when your next scan is due and whether it will be done at the same centre each time, so results are compared consistently.
Can I miss a monitoring appointment if I feel fine?
No — and feeling fine is not reassurance that the scan is unnecessary. Heart function changes from trastuzumab often occur before any symptoms appear. The monitoring schedule is designed to catch exactly those silent changes. A missed scan means a missed opportunity to act while the change is still small and reversible.
Do I need monitoring after trastuzumab has finished?
Your team will tell you whether ongoing heart checks are recommended after treatment ends. For most patients the question is settled by the end-of-treatment scan, but patients who had a change in heart function during treatment may need follow-up for longer. Ask your oncologist at your final treatment visit what the follow-up plan is and when any further scans should happen.