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Treatment with Beta-Blockers and ACE-Inhibitors in Breast Cancer Patients Receiving Adjuvant Trastuzumab-Based Therapy and Developing Mild Cardiac Toxicity: A Prospective Study

1
Multidisciplinary Oncology Outpatient Clinic, Candiolo Cancer Institute, FPO-IRCCS, 10060 Candiolo, Italy
2
Medical School, University of Turin, 10124 Turin, Italy
3
Oncologia Medica, Ospedale Cardinal Massaia, 14100 Asti, Italy
4
Cardiology Unit, Candiolo Cancer Institute, FPO-IRCCS, 10060 Candiolo, Italy
5
Clinical Research Office, Candiolo Cancer Institute, FPO-IRCCS, 10060 Candiolo, Italy
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Dipartimento di Scienze Cliniche e Biologiche, University of Turin, 10124 Turin, Italy
7
Clinical Laboratory, Candiolo Cancer Institute, FPO-IRCCS, 10060 Candiolo, Italy
*
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
Cancers 2020, 12(2), 327; https://doi.org/10.3390/cancers12020327
Received: 6 November 2019 / Revised: 26 January 2020 / Accepted: 29 January 2020 / Published: 31 January 2020
Background: Angiotensin Converting Enzyme inhibitors (ACEis) and beta-blockers (BB) are suggested to prevent and treat trastuzumab-related cardiac toxicity. We performed a prospective clinical trial in women experiencing mild cardiac toxicity (MCT) while on adjuvant treatment with trastuzumab. Methods: MCT was defined as an asymptomatic absolute decrease in LVEF of ≥ 10 percentage units to >50%. Treatment consisted of enalapril 2.5 mg bid and carvedilol 3.75 mg bid, which were up-titrated to 10 mg bid for the enalapril and 6.25 mg bid of carvedilol. In patients receiving study drug, the primary study end-point was LVEF recovery, which was defined as a post-trastuzumab LVEF returning to no less than −5 percentage points of the baseline value. Results: 103 patients were enrolled, 100 started trastuzumab, and 98 completed the planned treatment. Sixteen patients (16%) had MCT and received study drugs until trastuzumab completion. None of these patients achieved a post-trastuzumab LVEF recovery. Nevertheless, treated patients had significantly higher median LVEF recovery from nadir to post-trastuzumab LVEF in (8% points vs. 4% points, respectively, p = 0.004), resulting in no difference in post-treatment LVEF values compared to patients without MCT. Conclusion: Treatment of MCT with ACEis and BB allows faster LVEF recovery from nadir values and should be further studied in this setting. View Full-Text
Keywords: breast cancer; trastuzumab; cardiac toxicity; enalapril; carvedilol; ACE inhibitors; beta blockers breast cancer; trastuzumab; cardiac toxicity; enalapril; carvedilol; ACE inhibitors; beta blockers
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MDPI and ACS Style

Geuna, E.; Lombardi, P.; Martinello, R.; Garino, D.; Bonzano, A.; Galizia, D.; Nuzzo, A.; Berchialla, P.; Becco, P.; Mangioni, M.; De Zarlo, L.; Montemurro, F. Treatment with Beta-Blockers and ACE-Inhibitors in Breast Cancer Patients Receiving Adjuvant Trastuzumab-Based Therapy and Developing Mild Cardiac Toxicity: A Prospective Study. Cancers 2020, 12, 327. https://doi.org/10.3390/cancers12020327

AMA Style

Geuna E, Lombardi P, Martinello R, Garino D, Bonzano A, Galizia D, Nuzzo A, Berchialla P, Becco P, Mangioni M, De Zarlo L, Montemurro F. Treatment with Beta-Blockers and ACE-Inhibitors in Breast Cancer Patients Receiving Adjuvant Trastuzumab-Based Therapy and Developing Mild Cardiac Toxicity: A Prospective Study. Cancers. 2020; 12(2):327. https://doi.org/10.3390/cancers12020327

Chicago/Turabian Style

Geuna, Elena, Pasquale Lombardi, Rossella Martinello, Davide Garino, Alessandro Bonzano, Danilo Galizia, Annamaria Nuzzo, Paola Berchialla, Paolo Becco, Monica Mangioni, Lorena De Zarlo, and Filippo Montemurro. 2020. "Treatment with Beta-Blockers and ACE-Inhibitors in Breast Cancer Patients Receiving Adjuvant Trastuzumab-Based Therapy and Developing Mild Cardiac Toxicity: A Prospective Study" Cancers 12, no. 2: 327. https://doi.org/10.3390/cancers12020327

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