Treatment with Beta-Blockers and ACE-Inhibitors in Breast Cancer Patients Receiving Adjuvant Trastuzumab-Based Therapy and Developing Mild Cardiac Toxicity: A Prospective Study

Abstract

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: 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: 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: Treatment of MCT with ACEis and BB allows faster LVEF recovery from nadir values and should be further studied in this setting.

SARS-CoV-2 Infection and Lung Cancer: Potential Therapeutic Modalities

“…Research into the link between the RAS and cancer has accelerated greatly over the past years due to the growing evidence of local RAS signaling being deregulated in pathological tissues and the prominent role for the angiotensin receptors in tissue remodeling. As a result of the effects of ACE and the RAS as a whole, numerous studies have shown the association between ACE function and metabolic diseases such as diabetes as well as various cancers such as pancreatic and breast cancer [ 105 , 106 , 107 ]. Thus, drugs used to target RAS might also prove effective against cancer.…”

Strategies to Prevent Cardiovascular Toxicity in Breast Cancer: Is It Ready for Primetime?

“…Geuna et al demonstrated that patients post-trastuzumab treated with study drugs were able to achieve the same LVEF values of patients that did not develop cardiotoxicity. However, more large-scale inquiries must be carried out to verify these findings [60].…”