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ACE Inhibitor, Beta Blocker Lower Trastuzumab Cardiotoxicity Risk in HER2+ Breast Cancer

Wayne Kuznar
Published: Monday, Dec 10, 2018

Pamela N. Munster, MD

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.
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