Lexington, KY—Adding two common heart drugs to the drug regimen appears to help prevent cardiovascular issues related to breast cancer treatment, according to a new study.

The large multi-center study was presented at the American College of Cardiology’s 67th Annual Scientific Session. 

“This data is the crucial first step towards establishing a new standard of care to reduce the risk of cardiotoxicity for patients undergoing treatment for HER2-positive breast cancer,” explained study chair Maya Guglin MD, PhD, of the University of Kentucky’s Gill Heart & Vascular Institute.

Background information in the report notes that trastuzumab (TZB) is a preferred therapy for HER2 positive breast cancer but can be associated with cardiotoxicity presenting as asymptomatic decrease in left ventricular ejection fraction (LVEF) or even overt heart failure. 

The study authors sought to determine if using an ACE inhibitor or a beta-blocker during TZB therapy would help prevent decrease in LVEF.

In the prospective, multicenter, clinical trial, 468 breast cancer patients receiving adjuvant or neoadjuvant TZB were randomized to lisinopril, carvedilol phosphate-extended release, or placebo. In addition to the primary endpoint—change in LVEF—researchers looked at whether participants in the intervention groups had fewer interruptions in TZB therapy and determined if treatment effects were consistent in anthracycline and nonanthracycline cohorts. 

Results indicate that while neither drug was statistically different from placebo for prevention of cardiotoxicity caused by TZB and the number of patients who had to interrupt treatment with TZB was similar over the three arms of the study, both carvedilol and lisinopril were statistically different than placebo (two-tailed P values <0.05) in patients who were previously treated with anthracyclines. In fact, study authors report, the hazard ratios for carvedilol (HR = 0.49) and lisinopril (HR = 0.53) in the anthracycline cohort indicate a significant drug benefit, with carvedilol demonstrating fewer adverse events.

“In this prospective randomized placebo controlled clinical trial, neither lisinopril nor carvedilol demonstrated prevention of trastuzumab-induced cardiotoxicity. On the other hand, both drugs were effective in preservation of left ventricular ejection fraction in 
the cohort with prior exposure to anthracyclines,” study authors conclude.

“Herceptin is arguably the most effective treatment for HER2-positive breast cancer,” Guglin added. “These patients are already anxious about their future. We don’t want to avoid this exceptionally effective treatment just because it might cause damage to the heart.”
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