Cardiovascular Drugs May Lower Heart Disease Risk from Breast Cancer Chemotherapy

Some breast cancer drugs have been linked to serious adverse events among patients. The American Heart Association recently issued a scientific statement that warns the cardiovascular risks associated with breast cancer drugs may outweigh the benefits. Certain patients may be more likely to die from heart disease related to treatment rather than cancer itself, according to the statement.

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A study recently presented at the American College of Cardiology 2018 meeting suggests that certain drugs may prevent cardiotoxicity in patients treated with some chemotherapies.

The researchers found that the addition of lisinopril or carvedilol prevented toxicity among patients treated with anthracycline and trastuzumab chemotherapies; however, the heart drugs did not prevent toxicity among patients treated with trastuzumab monotherapy.

The goal of the study was to determine whether lisinopril or carvedilol reduces cardiotoxicity compared with placebo in patients with breast cancer administered trastuzumab.

Included in the study were 468 patients with HER2-positive breast cancer scheduled to receive trastuzumab who were randomized to also receive either of the cardiovascular drugs or placebo for 2 years. Approximately half of the patients were also treated with anthracycline.

All patients had a similar cardiovascular risk profile. The authors noted that patients had left ventricular ejection fraction (LVEF) of ≥50% at baseline.

The primary endpoint of the trial was cardiotoxicity defined as ≥10% reduction in LVEF compared with baseline or an overall reduction of ≥5% in LVEF among patients with LVEF <50% at study follow-up, according to the authors.

Secondary endpoints included interruptions in trastuzumab and effects of the drugs in patients who did or did not receive anthracycline.

The authors discovered that cardiotoxicity was similar among lisinopril, carvedilol, and placebo cohorts. Trastuzumab interruptions were also observed to be similar in the 3 groups, according to the study.

Notably, carvedilol and lisinopril effectively prevented LVEF worsening among patients treated with an anthracycline. In this group, the heart drugs reduced declines in heart function by 50% compared with placebo, according to the study.

Adverse cardiac events occurred in 32% of patients in the placebo cohort, 29% in the carvedilol cohort, and 30% in the lisinopril cohort, according to the study. The most frequent adverse events for these patients included low blood pressure and dizziness.

"Our study indicates that carvedilol is tolerated better," said study presenter Maya E. Guglin, MD, FACC. "But based on our study, if you have breast cancer and your oncologist wants to start you on Herceptin and you've been on an anthracycline, you have a better chance of avoiding decline in cardiac function and taking Herceptin without damaging your heart if you are pretreated with lisinopril or carvedilol, whichever is tolerated better."