Author + information
- Maya E. Guglin,
- Roy Tamura,
- Lauren Bello-Matricaria,
- Angelina Fink,
- Jeffrey Krischer and
- Pamela Munster
Trastuzumab is a highly effective drug for breast cancer, but it is cardiotoxic, especially if used after anthracyclines. Monitoring of left ventricular ejection fraction (LVEF) is required. Several studies found benefit of angiotensin converting enzyme inhibitors and beta blockers for prevention of cardiotoxicity.
In a randomized, double-blind, placebo-controlled, multicenter clinical trial, we recruited patients with breast cancer into two cohorts. The anthracycline cohort received with anthracyclines and trastuzumab. The non-anthracycline cohort received trastuzumab only. Within each cohort, we randomized patients to lisinopril, carvedilol, or placebo for prevention of cardiotoxicity. The study lasted two years (1 year of trastuzumab therapy and 1 year of follow-up). We analyzed changes in LVEF for each group.
The study included 468 patients enrolled in 127 sites. In the anthracycline cohort, LVEF decreased in all three arms, with the largest decrease in the placebo group (see Table). In the non-anthracycline (trastuzumab only) arm LVEF did not change in the lisinopril group and minimally changed in other groups.
In patients with breast cancer treated with trastuzumab in a non-anthracycline regimen, monitoring of LVEF every 3 months is excessive and may not be necessary. Attempts to prevent cardiotoxicity are unjustified. In the anthracyclines plus trastuzumab arm, both monitoring of LVEF and pharmacologic prevention is reasonable.
|Changes of LVEF on Anthracycline and Non-anthracycline regimen|
|Cohort||Group||Time||LVEF, % ±SD||P|
Poster Hall, Hall F
Sunday, March 17, 2019, 3:45 p.m.-4:30 p.m.
Session Title: Heart Failure and Cardiomyopathies: Clinical 4
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1284-509
- 2019 American College of Cardiology Foundation