Guglin, M. et. al.

Randomized Trial of Lisinopril Versus Carvedilol to Prevent Trastuzumab Cardiotoxicity in Patients with Breast Cancer

J Am Cardiol. 2019;73(22):2859-68
DOI: 10.1016/j.jacc.2019.03.495

It is standard of care to consider targeted therapy in cases of HER-2 positive breast cancer. Trastuzumab is the chemotherapy agent most often used. The risk of trastuzumab causing cardiomyopathy (decreased heart function due to weakened muscle) is well-known, and this is a frequent reason why the medication is stopped during a treatment regimen. The risk of cardiomyopathy is greater when a patient is treated with an anthracycline in addition to trastuzumab.

This study observed over 460 women with HER2-positive breast cancer who received trastuzumab as part of their therapy. The group was randomized into three treatment subgroups: placebo, lisinopril and carvedilol. The women were followed for two years.

Among the women who received anthracyclines in addition to trastuzumab, those treated by placebo had a higher rate of cardiac complications compared to those on lisinopril or carvedilol (47% vs.37% and 31%, respectively). The women in the latter two groups also lived longer without cardiac issues compared to the women treated with placebo.

There were some drawbacks to the study. The number of patients was small and the method of assessing cardiac function was not as detailed as in other studies. However, this study adds to the understanding that specific cardiac medications can treat or prevent complications related to HER2-targeted chemotherapy. Using such medications may permit more patients to complete their full breast cancer chemotherapy regimens.