Pamela N. Munster, MD
In patients with early-stage HER2-positive breast cancer who are being treated with adjuvant trastuzumab and anthracyclines, cardiotoxicity-free survival is longer when they receive prophylactic simultaneous lisinopril or carvedilol, according to data from a large, community-based, double-blind, placebo-controlled prospective trial.
In the study, which randomized 486 patients, cardiotoxicity was defined as an absolute decrease in left ventricular ejection fraction (LVEF) of ≥10%, or a ≥5% decrease for LVEF <50%. Cardiotoxicity developed in 32% of the placebo arm, 29% of the carvedilol arm (P
= .270), and 30% of the lisinopril arm (P
= .358) in the overall cohort at about 24 months after baseline examination.
In the overall cohort, cardiotoxicity-free survival was also comparable between the arms, with a hazard ratio of 0.71 for carvedilol versus placebo (P
= .052) and 0.74 for lisinopril (P
= .076). When the study population was stratified by anthracycline use, cardiotoxicity-free survival was significantly lower in the carvedilol (HR, 0.49; P
= .009) and lisinopril (HR, 0.30; P
= .015) arms in patients taking an anthracycline. No differences were observed in the nonanthracycline cohort.
... to read the full story