Effectiveness of sacubitril–valsartan in cancer patients with heart failure

Abstract

Aims Current guidelines recommend sacubitril/valsartan for patients with heart failure and reduced left ventricular ejection fraction (LVEF), but there is lack of evidence of its efficacy and safety in cancer therapy-related cardiac dysfunction (CTRCD). Our aim was to analyse the potential benefit of sacubitril/valsartan in patients with CTRCD. Methods and resultsWe performed a retrospective multicentre registry (HF-COH) in six Spanish hospitals with cardiooncology clinics including all patients treated with sacubitril/valsartan. Demographic and clinical characteristics and laboratory and echocardiographic data were collected. Median follow-up was 4.6 [1; 11] months. Sixty-seven patients were included (median age was 63 ± 14 years; 64% were female, 87% had at least one cardiovascular risk factor). Median time from anti-cancer therapy to CTRD was 41 [10; 141] months. Breast cancer (45%) and lymphoma (39%) were the most frequent neoplasm, 31% had metastatic disease, and all patients were treated with combination antitumor therapy (70% with anthracyclines). Thirtynine per cent of patients had received thoracic radiotherapy. Baseline median LVEF was 33 [27; 37], and 21% had atrial fibrillation. Eighty-five per cent were on beta-blocker therapy and 76% on mineralocorticoid receptor antagonists; 90% of the patients were symptomatic NYHA functional class ≥II. Maximal sacubitril/valsartan titration dose was achieved in 8% of patients (50 mg b.i.d.: 60%; 100 mg b.i.d.: 32%). Sacubitril/valsartan was discontinued in four patients (6%). Baseline Nterminal pro-B-type natriuretic peptide levels (1552 pg/mL [692; 3624] vs. 776 [339; 1458]), functional class (2.2 ± 0.6 vs. 1.6 ± 0.6), and LVEF (33% [27; 37] vs. 42 [35; 50]) improved at the end of follow-up (all P values ≤0.01). No significant statistical differences were found in creatinine (0.9 mg/dL [0.7; 1.1] vs. 0.9 [0.7; 1.1]; P = 0.055) or potassium serum levels (4.5 mg/dL [4.1; 4.8] vs. 4.5 [4.2; 4.8]; P = 0.5). Clinical, echocardiographic, and biochemical improvements were found regardless of the achieved sacubitril-valsartan dose (low or medium/high doses). Conclusions Our experience suggests that sacubitril/valsartan is well tolerated and improves echocardiographic functional and structural parameters, N-terminal pro-B-type natriuretic peptide levels, and symptomatic status in patients with CTRCD.

Use of Sacubitril/valsartan in patients with cardio toxicity and heart failure due to chemotherapy

“…The importance of oncological patients completing their specific therapy creates the need to improve the treatment of heart failure in this subgroup of patients in order to meet this goal [ 13 , 14 ].…”

A case series about the favorable effects of sacubitril/valsartan on anthracycline cardiomyopathy

“…However, a retrospective cohort study was recently performed to analyze the potential benefit of sacubitril/valsartan in patients with CTRCD 17 In this study, baseline NT-proBNP levels (1552 pg/mL (692; 3624) versus 776 (339; 1458)), functional class (2.2 ± 0.6 versus 1.6 ± 0.6), and LVEF (33% (27; 37) versus 42% (35; 50)) improved at the end of follow-up (all p-values ⩽ 0.01). Biochemical, clinical, and echocardiographic improvements were found regardless of the achieved sacubitril–valsartan dose (low or medium/high doses).…”

“…Biochemical, clinical, and echocardiographic improvements were found regardless of the achieved sacubitril–valsartan dose (low or medium/high doses). 17 …”

“…Biochemical, clinical, and echocardiographic improvements were found regardless of the achieved sacubitril-valsartan dose (low or medium/high doses). 17 Outside of this observational study, there are currently no exhaustive data on the subject, at most you can find anecdotal reports 18 or reports on the experimental application of the drug to investigational animal models of doxorubicin-induced cardiotoxicity. 19 In this context characterized by a lack of guidelines concerning the use of sacubitril/valsartan in heart failure arisen in cancer patients, our contribution seems to be useful to us.…”

In ®Entresto we trust

“…On the basis of data from a retrospective multicenter registry, Martín-García et al [12] showed that S/V was well tolerated and could improve myocardial function and structure in 67 cancer patients with CTRCD, mainly in the settings of breast cancer (45%) and lymphomas (39%). Seventy percent of these patients had been treated with anthracyclines and a total of 12% had received the anti-HER2 antibody, trastuzumab.…”