Prevention of Trastuzumab and Anthracycline-induced Cardiotoxicity Using Angiotensin-converting Enzyme Inhibitors or β-blockers in Older Adults With Breast Cancer

Wittayanukorn, Saranrat; Qian, Jingjing; Westrick, Salisa C.; Billor, Nedret; Johnson, Brandon; Hansen, Richard A

doi:10.1097/coc.0000000000000389

Cited by 42 publications

(26 citation statements)

References 47 publications

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“…The adjusted hazard ratio for cardiotoxicity and allcause mortality was 0.77 (95% CI, 0.62 to 0.95) in the ACEI group and 0.79 (95% CI, 0.70 to 0.90) in the BB group, compared to the hazards in the non-exposed (to either ACEI or BB) group. Starting ACEIs/BBs ≤6 months after the initiation of trastuzumab/anthracyclines and having exposed duration of ≥6 months were associated with decreased risk of cardiotoxicity and allcause mortality [98]. Although suggesting a clinical benefit, the results are from an observational study and cannot be attributed to specific medications or drug classes or to primary, secondary, or tertiary prevention.…”

Section: Clinical Studies In Adultsmentioning

confidence: 81%

Strategies to prevent anthracycline-induced cardiotoxicity in cancer survivors

et al. 2019

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Cancer diagnostics and therapies have improved steadily over the last few decades, markedly increasing life expectancy for patients at all ages. However, conventional and newer anti-neoplastic therapies can cause short-and long-term cardiotoxicity. The clinical implications of this cardiotoxicity become more important with the increasing use of cardiotoxic drugs. The implications are especially serious among patients predisposed to adverse cardiac effects, such as youth, the elderly, those with cardiovascular comorbidities, and those receiving additional chemotherapies or thoracic radiation. However, the optimal strategy for preventing and managing chemotherapyinduced cardiotoxicity remains unknown. The routine use of neurohormonal antagonists for cardioprotection is not currently justified, given the marginal benefits and associated adverse events, particularly with long-term use. The only United States Food and Drug Administration and European Medicines Agency approved treatment for preventing anthracycline-related cardiomyopathy is dexrazoxane. We advocate administering dexrazoxane during cancer treatment to limit the cardiotoxic effects of anthracycline chemotherapy.

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Section: Clinical Studies In Adultsmentioning

confidence: 81%

Strategies to prevent anthracycline-induced cardiotoxicity in cancer survivors

et al. 2019

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“…One of the new generation BBs and a most commonly used agent, carvedilol, showed strong antioxidant characteristics and greater protective effect on anthracycline-induced cardiomyopathy ( 6 , 8 ). A recent report demonstrated that favorable effects of ACE inhibitors and BBs on preventing cardiotoxicity and improving survival of breast cancer patients treated with trastuzumab and/or anthracyclines ( 65 ). Moreover, beta-adrenergic blockade with nebivolol, metoprolol, lisinopril, etc., has also been proven to be effective for cardiomyopathy ( 66 , 67 ).…”

Section: Prevention Of Cardiotoxicity and Future Directionsmentioning

confidence: 99%

Cardiotoxicity of Anticancer Therapeutics

Dong

Chen

2018

Front. Cardiovasc. Med.

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As cancer therapeutics continues to improve and progress, the adverse side effects associated with anticancer treatments have also attracted more attention and have become extensively explored. Consequently, the importance of posttreatment follow-ups is becoming increasingly relevant to the discussion. Contemporary treatment methods, such as tyrosine kinase inhibitors, anthracycline chemotherapy, and immunotherapy regimens are effective in treating different modalities of cancers; however, these reagents act through interference with DNA replication or prevent DNA repair, causing endothelial dysfunction, generating reactive oxygen species, or eliciting non-specific immune responses. Therefore, cardiotoxic effects, such as hypertension, heart failure, and left ventricular dysfunction, arise posttreatment. Rising awareness of cardiovascular complications has led to meticulous attention for the evolution of treatment strategies and carefully monitoring between enhanced treatment effectiveness and minimization of adverse toxicity to the cardiovasculature, in which psychological assessments, early detection methods such as biomarkers, magnetic resonance imaging, and various drugs to reverse the damage from cardiotoxic events are more prevalent and their emphasis has increased tremendously. Fully understanding the mechanisms by which the risk factors action for various patients undergoing cancer treatment is also becoming more prevalent in preventing cardiotoxicity down the line.

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“…This gap in knowledge of how to manage a large proportion of pediatric cancer patients needs to be addressed. For example, while multiple clinical trials in adults have reported a benefit with ACE inhibitors [17], there are very few pediatric trials in cancer patients with mixed results. A recent trial that randomized 84 pediatric patients with leukemia to receive 6 months of ACE inhibitor did not show a difference in left ventricular systolic dysfunction between treatment and placebo groups; however, fewer patients in the treatment group showed an increase in pro-brain natriuretic peptide compared to the placebo group [18].…”

Section: Developing Standardized Practicementioning

confidence: 99%

The landscape of cardiovascular care in pediatric cancer patients and survivors: a survey by the ACC Pediatric Cardio-Oncology Work Group

et al. 2019

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Objective: To enhance the understanding of cardiovascular care delivery in childhood cancer patients and survivors. Study design: A 20-question survey was created by the Pediatric Cardio-oncology Work Group of the American College of Cardiology (ACC) Cardio-oncology Section to assess the care, management, and surveillance tools utilized to manage pediatric/young adult cardio-oncology patients. The survey distribution was a collaborative effort between Cardio-oncology Section and membership of the Adult Congenital and Pediatric Cardiology Section (ACPC) of the ACC. Results: Sixty-five individuals, all self-identified as physicians, responded to the survey. Most respondents (n = 58, 89%) indicated childhood cancer patients are regularly screened prior to and during cancer therapy at their centers, predominantly by electrocardiogram (75%), standard echocardiogram (58%) and advanced echocardiogram (50%) (i.e. strain, stress echo). Evaluation by a cardiologist prior to/during therapy was reported by only 8(12%) respondents, as compared to post-therapy which was reported by 28 (43%, p < 0.01). The most common indications for referral to cardiology at pediatric centers were abnormal test results (n = 31,48%) and history of chemotherapy exposure (n = 27,42%). Of note, during post-treatment counseling, common cardiovascular riskfactors like blood pressure (31,48%), lipid control (22,34%), obesity & smoking (30,46%) and diet/exercise/weight loss (30,46%) were addressed by fewer respondents than was LV function (72%). Conclusions: The survey data demonstrates that pediatric cancer patients are being screened by EKG and/or imaging prior to/during therapy at most centers. Our data, however, highlight the potential for greater involvement of a cardiovascular specialist for pre-treatment evaluation process, and for more systematic cardiac risk factor counseling in posttreatment cancer survivors.

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Prevention of Trastuzumab and Anthracycline-induced Cardiotoxicity Using Angiotensin-converting Enzyme Inhibitors or β-blockers in Older Adults With Breast Cancer

Abstract: ACEIs/BBs show favorable effects on preventing cardiotoxicity and improving survival in female breast cancer patients undergoing trastuzumab/anthracycline treatment.

Cited by 42 publications

References 47 publications

Strategies to prevent anthracycline-induced cardiotoxicity in cancer survivors

Strategies to prevent anthracycline-induced cardiotoxicity in cancer survivors

Cardiotoxicity of Anticancer Therapeutics

The landscape of cardiovascular care in pediatric cancer patients and survivors: a survey by the ACC Pediatric Cardio-Oncology Work Group

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