When your checks happen
Cycle numbers are examples for uninterrupted three-weekly treatment. Schedule checks by elapsed time and clinical need. Moving to maintenance does not restart the cardiac-monitoring clock. The clinical team books and reviews results; this map does not track completed tests.
| Check | Before this phase | Before every 21-day cycle | Week 12 · around C5 | Weeks 24 / 36 · around C9 / C13 | Later / treatment change |
|---|---|---|---|---|---|
| Heart pumping test · echo / MUGA | Review baseline / latest cardiac assessment and the next due date | Review symptoms; echo is not automatically needed before every infusion | Repeat at 12 weeks; earlier if symptoms or impairment | Continue every 12 weeks; preserve the existing due date | NCCP 12-weekly default while treatment continues; a different interval needs an explicit specialist plan. |
| Blood tests | Baseline FBC, renal and liver profile | FBC, renal and liver tests before every cycle | Continue pre-cycle blood tests | Continue pre-cycle blood tests | Follow abnormalities and the next treatment plan |
| Cancer imaging / markers | Record disease sites and the comparison scan | Review new symptoms at every visit | Metastatic: response scans when due under the individual plan | Individual scan interval; markers only if informative | Metastatic scans commonly every 2–4 months; not an NCCP fixed-cycle rule |
| ECG / bone health | ECG when indicated by cardiac assessment; DEXA only if endocrine / fracture risk indicates | No automatic every-cycle ECG or DEXA | Risk-based clinical plan | Risk-based clinical plan | Keep any separately prescribed endocrine and bone-health follow-up |
HER2 maintenance: treatment and checks continue
Maintenance · HER2-positive metastatic / unresectable recurrent breast cancer
Pertuzumab and trastuzumab continue after the chemotherapy part of the metastatic treatment plan. Maintenance remains active treatment, with response and heart checks.
On a small screen, swipe the map sideways. The checks below give the same timing in words.
| Care / check | Earlier combination | Maintenance transition | Every 3 weeks | Regular response review | Beyond year 1 |
|---|---|---|---|---|---|
| Cancer medicinesNCCP 00726 | Chemotherapy with HER2 treatment | Review benefit, tolerance and last dose date | Pertuzumab + trastuzumab infusions | Continue while benefit and tolerance support the plan | Ongoing treatment; no fixed one-year stopping rule |
| Local / endocrine careMETASTATIC · EARLY | Prior surgery or radiation varies | Discuss symptom-directed local treatment | Radiotherapy only if separately indicated | Endocrine therapy may be considered if HR-positive | MDT agrees any changes |
| Blood testsNCCP 00726 | Carry previous results forward | Blood count, kidney and liver tests | Before each cycle | Additional tests when indicated | Continue according to the active regimen |
| Heart ultrasoundNCCP 00726 · ESC | Count from first HER2 exposure | Check latest echo and due interval | Symptoms reviewed every visit | NCCP: echo every 12 weeks | 12-weekly default; interval changes require cardiac risk review |
| Cancer scansMETASTATIC | Baseline extent documented | Use prior scans as comparison | Report new symptoms between scans | Usually every 2–4 months; modality / interval individualised | Keep a documented response-assessment plan |
| Tumour markersMARKERS | Consider if informative | Confirm whether used for this person | No universal marker schedule | Adjunct to symptoms and scans, never alone | Continue only when clinically useful |
What each check is for
1Heart ultrasoundNCCP: baseline and every 12 weeks during HER2 treatment
Checks heart function while treatment continues.
Ask / act: Ask when the next echo is due; a move to maintenance does not restart the clock.
Sources: NCCP 00726 · ESC
2Response imagingUsually every 2–4 months; earlier if clinically needed
A baseline scan records where the cancer is. Response is usually reviewed every 2–4 months, adjusted for the treatment, disease pace, symptoms and previous results. CT chest/abdomen/pelvis is common when appropriate; the team chooses the imaging needed for the known sites.
Ask / act: Ask what scan is planned, when results will be discussed and who to contact for new symptoms.
Sources: METASTATIC
3Tumour markers, if usefulOnly if included in the individual monitoring plan
CA 15-3 or CEA may be helpful in selected metastatic cases, especially if previously raised. They support the assessment with symptoms and imaging; a marker alone does not decide whether treatment is working or should change.
Ask / act: Ask what a change means alongside the scan and clinical review.
Sources: MARKERS
4Missed or delayed infusionWhenever a treatment gap occurs
A long gap can change the required antibody loading doses.
Ask / act: Contact the team to confirm the new prescription; do not assume the old visit plan still applies.
Sources: NCCP 00726
5Separate early-breast pathwaysAt every transition
This particular NCCP code is for metastatic/unresectable recurrent maintenance.
Ask / act: Ask the team to confirm the setting and aim on the written plan.
Sources: NCCP 00726
At the next review, ask
- Which treatment phase am I in, and what happens next?
- Which test is expected next, who arranges it, and who explains the result?
- Who should I contact if an expected appointment has not arrived?
This map does not show whether a test has been ordered, booked or completed. Do not wait for a scheduled test if you develop new symptoms.