Treatment with Beta-Blockers and ACE-Inhibitors in Breast Cancer Patients Receiving Adjuvant Trastuzumab-Based Therapy and Developing Mild Cardiac Toxicity: A Prospective Study.
ACE inhibitors
beta blockers
breast cancer
cardiac toxicity
carvedilol
enalapril
trastuzumab
Journal
Cancers
ISSN: 2072-6694
Titre abrégé: Cancers (Basel)
Pays: Switzerland
ID NLM: 101526829
Informations de publication
Date de publication:
31 Jan 2020
31 Jan 2020
Historique:
received:
06
11
2019
revised:
26
01
2020
accepted:
29
01
2020
entrez:
7
2
2020
pubmed:
7
2
2020
medline:
7
2
2020
Statut:
epublish
Résumé
Angiotensin Converting Enzyme inhibitors (ACEis) and beta-blockers (BB) are suggested to prevent and treat trastuzumab-related cardiac toxicity. We performed a prospective clinical trial in women experiencing mild cardiac toxicity (MCT) while on adjuvant treatment with trastuzumab. MCT was defined as an asymptomatic absolute decrease in LVEF of ≥ 10 percentage units to >50%. Treatment consisted of enalapril 2.5 mg bid and carvedilol 3.75 mg bid, which were up-titrated to 10 mg bid for the enalapril and 6,25 mg bid of carvedilol. In patients receiving study drug, the primary study end-point was LVEF recovery, which was defined as a post-trastuzumab LVEF returning to no less than -5 percentage points of the baseline value. 103 patients were enrolled, 100 started trastuzumab, and 98 completed the planned treatment. Sixteen patients (16%) had MCT and received study drugs until trastuzumab completion. None of these patients achieved a post-trastuzumab LVEF recovery. Nevertheless, treated patients had significantly higher median LVEF recovery from nadir to post-trastuzumab LVEF in (8% points vs. 4% points, respectively, p = 0.004), resulting in no difference in post-treatment LVEF values compared to patients without MCT. Treatment of MCT with ACEis and BB allows faster LVEF recovery from nadir values and should be further studied in this setting.
Sections du résumé
BACKGROUND
BACKGROUND
Angiotensin Converting Enzyme inhibitors (ACEis) and beta-blockers (BB) are suggested to prevent and treat trastuzumab-related cardiac toxicity. We performed a prospective clinical trial in women experiencing mild cardiac toxicity (MCT) while on adjuvant treatment with trastuzumab.
METHODS
METHODS
MCT was defined as an asymptomatic absolute decrease in LVEF of ≥ 10 percentage units to >50%. Treatment consisted of enalapril 2.5 mg bid and carvedilol 3.75 mg bid, which were up-titrated to 10 mg bid for the enalapril and 6,25 mg bid of carvedilol. In patients receiving study drug, the primary study end-point was LVEF recovery, which was defined as a post-trastuzumab LVEF returning to no less than -5 percentage points of the baseline value.
RESULTS
RESULTS
103 patients were enrolled, 100 started trastuzumab, and 98 completed the planned treatment. Sixteen patients (16%) had MCT and received study drugs until trastuzumab completion. None of these patients achieved a post-trastuzumab LVEF recovery. Nevertheless, treated patients had significantly higher median LVEF recovery from nadir to post-trastuzumab LVEF in (8% points vs. 4% points, respectively, p = 0.004), resulting in no difference in post-treatment LVEF values compared to patients without MCT.
CONCLUSION
CONCLUSIONS
Treatment of MCT with ACEis and BB allows faster LVEF recovery from nadir values and should be further studied in this setting.
Identifiants
pubmed: 32023877
pii: cancers12020327
doi: 10.3390/cancers12020327
pmc: PMC7072182
pii:
doi:
Types de publication
Journal Article
Langues
eng
Subventions
Organisme : Associazione Italiana per la Ricerca sul Cancro
ID : IG 2016, project code 19174
Organisme : Rete Oncologica del Piemonte e della Valle d'Aosta
ID : Cardiorete
Organisme : Ministero della Salute
ID : Ricerca Corrente
Déclaration de conflit d'intérêts
Filippo Montemurro has received speaker’s honoraria from Roche, Novartis, Eli Lilly and Pfizer, advisory board honoraria from Roche and travel grants from Roche. Danilo Galizia has received travel grants from Pfizer, BMS, Merck, Novartis and Roche and speakers' honoraria from BMS. All the other authors do not have significant conflicts of interest to disclose.
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