Two kinds of heart medications, angiotensin-converting enzyme (ACE) inhibitors and beta blockers, can help to prevent a decline in heart function from breast cancer treatment, according to new research published in the Journal of Clinical Oncology.
A five-year study, led by Edith Pituskin, RN, MN, PhD, University of Alberta, and Ian Paterson, Department of Medicine, University of Alberta, analyzed the effects of ACE inhibitors and beta blockers in preventing trastuzumab-related cardiotoxicity for patients with HER2-positive early breast cancer. Researchers sampled 94 patients with HER2-positive early breast cancer in a double-blinded, placebo-controlled trial. Patients were randomly assigned to treatment with perindopril (ACE inhibitor), bisoprolol (beta blocker), or placebo (1:1:1) for the duration of trastuzumab adjuvant therapy. Cardiac magnetic resonance imaging was used at baseline and post-cycle 17 for sampling of left ventricular volumes and left ventricular ejection fraction (LVEF). Cardiotoxicity was measured as the change in left ventricular end diastolic volume and LVEF.
Results showed that after 17 cycles of trastuzumab, left ventricular end diastolic volume increased in patients treated with perindopril (+7 ± 14 mL/m2), bisoprolol (+8 mL ± 9 mL/m2), and placebo (+4 ± 11 mL/m2; P = .36). Decline in LVEF was significantly less in bisoprolol-treated patients (−1 ± 5%) relative to the perindopril (−3 ± 4%) and placebo (−5 ± 5%) groups (P = .001). These results demonstrate that perindopril and bisoprolol protect patients with HER2-positive early breast cancer who receive trastuzumab from cancer therapy-related declines in heart function.
Dr Paterson indicated that these ACE inhibitors and beta blockers not only protect the heart from any damage, but may also improve breast cancer survival rates by limiting interruptions to chemotherapy treatment.
"We are aiming for two outcomes for these patients—we're hoping to prevent heart failure and we're hoping for them to receive all the chemotherapy that they are meant to get, when they are supposed to get it—to improve their odds of remission and survival," he said.