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What kind of exercise while on Herceptin?

Page last modified on: November 20, 2008
Question from JHA: I am taking Herceptin and my heart muscle is sufficient to continue treatment, but not optimum (53% by MUGA test). Can I continue exercising, and if so, how vigorous and what type is best to avoid congestive heart failure?
Answer —Generosa Grana, M.D., F.A.C.P.: You are alluding to the fact that Herceptin can cause cardiac toxicity, in particular damage to the muscle of the heart. This can lead to congestive heart failure, which is weakening of the muscle of the heart and subsequent accumulation of fluid, fatigue, and other symptoms. There is no good data on what the outcome is for women who do have damage from Herceptin. There is a feeling that this damage is not as severe as what we have seen in the past with Adriamycin, and that it might improve when the Herceptin is discontinued, but the reality is that we don't have much information on which to base that.

As to how to avoid the cardiac toxicity, once you are on Herceptin we don't have anything we can do that we know will improve that. The role of exercise is completely unknown, and I would discuss that, if at all, with a cardiologist who might be able to give you some guidance on exercise and its role and safety.

What I do tend to do in women who have a heart test (a MUGA scan) in the low normal range (50-55%) is to often repeat it in a month or two, rather than traditionally waiting three months. That way, we make sure if there is a decline, the Herceptin can be stopped before irreversible damage is done.

In early-stage breast cancer, most people would not be comfortable restarting Herceptin unless the ejection fraction goes up to the normal range again. (Ejection fraction is the pumping capacity of the heart. Normal is above 50%.) The clinical trials have built in hold points for Herceptin so that if it drops below a certain point, the drug has to be held and if it improves, it can be resumed but there are certain criteria that led to complete discontinuation of the drug. These included a drop by more than 15% in the ejection fraction, or clinical symptoms of congestive heart failure.

On Wednesday, December 21, 2005, our Ask-the-Expert Online Conference was called Updates from San Antonio Breast Cancer Symposium 2005. Generosa Grana, M.D., F.A.C.P. and moderator Marisa Weiss, M.D. brought you the highlights of the 2005 Breast Cancer Symposium and answered your questions about the latest diagnostic and treatment options for breast cancer.

The materials presented in these conferences do not necessarily reflect the views of breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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Meet the Experts

Generosa Grana, M.D., F.A.C.PGenerosa Grana, M.D., F.A.C.P. is the director of the Cooper Cancer Institute and heads the division of hematology/medical oncology at Cooper University Hospital.

Marisa Weiss, M.D. is a radiation oncologist specializing in breast cancer and the founder, president, and guiding force behind Breastcancer.org.

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