Time to Personalize Surveillance for Cancer Therapy-Related Cardiac Dysfunction in HER2-Targeted Therapy: One Size Does Not Fit All

PURPOSE OF REVIEW: Cancer therapy-related cardiac dysfunction (CTRCD) remains a significant risk of contemporary cancer treatment. Despite advances in oncologic therapies, cardiac surveillance strategies have largely relied on uniform, intensive monitoring, often without consideration of individual cardiotoxicity risk. This review evaluates the rationale for transitioning from blanket surveillance to risk-based, personalized cardiac monitoring strategies, especially for HER2-targeted therapy. RECENT FINDINGS: Evolving definitions of CTRCD and improved risk stratification tools, have highlighted substantial heterogeneity in cardiotoxicity risk. Prospective studies in low-risk patients receiving non-anthracycline HER2-targeted therapies demonstrate that reduced-frequency echocardiographic surveillance appears safe and does not compromise cardiovascular or oncologic outcomes. Similar paradigms need to be studied for other cardiotoxic therapies, including BRAF/MEK inhibitors and VEGF inhibitors, with a need for prospective validation before clinical application. Risk-adapted cardiac surveillance offers a pragmatic, evidence-based approach to optimize resource utilization while maintaining patient safety. Future research should focus on prospective validation and guideline harmonization to enable personalized cardio-oncology care.