ACC 2018: Managing Cardiotoxicity in Patients Receiving Breast Cancer Chemotherapy
Posted: Wednesday, March 14, 2018
Although both the ACE inhibitor lisinopril and the beta-blocker carvedilol failed to prevent cardiotoxicity in patients with breast cancer treated with trastuzumab alone, both drugs prevented cardiotoxicity in patients who received anthracycline therapy (doxorubicin) in addition to trastuzumab. These findings were presented by Maya E. Guglin, MD, PhD, FACC, of the University of Kentucky Gill Heart & Vascular Institute, at the 2018 Annual Scientific Session & Expo of the American College of Cardiology (ACC; Abstract 405-14).
The researchers were investigating whether the administration of lisinopril or carvedilol decreases cardiotoxicity compared with placebo in patients with breast cancer undergoing treatment with trastuzumab. A total of 468 patients with HER2-positive breast cancer scheduled to receive adjuvant trastuzumab therapy were randomized to receive lisinopril (10 mg), carvedilol (10 mg), or placebo for 2 years. Half of the patients were receiving or had received an anthracycline, and half had not.
Carvedilol and lisinopril were effective in preserving left ventricular ejection fraction in patients who were treated with an anthracycline. Both drugs reduced declines in heart function by half compared with placebo, a statistically significant difference.
“Based on our study,” emphasized Dr. Guglin in an ACC press release, “if you have breast cancer and your oncologist wants to start you on trastuzumab and you’ve been on an anthracycline, you have a better chance of avoiding decline in cardiac function and taking trastuzumab without damaging your heart if you are pretreated with lisinopril or carvedilol, whichever is tolerated better.”
