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Dr. Maya Guglin

Two drugs protect breast cancer patients' heart function

A multicenter NCI-funded study examined the effectiveness of two drugs used to prevent heart problems resulting from breast cancer treatment.

“This data is the crucial first step toward establishing a new standard of care to reduce the risk of cardiotoxicity for patients undergoing treatment for HER2-positive breast cancer,” said study chair Dr. Maya Guglin of the UK Gill Heart & Vascular Institute.

Herceptin's success comes at a cost

The chemotherapy drug Herceptin was created to treat an aggressive form of breast cancer called HER2-positive. However, its stunning success at reducing cancer recurrence and improving survival came at a cost: One in four women who receive the drug develops potentially dangerous heart problems. Physicians began suspending Herceptin treatment or reducing frequency of treatment if a patient’s ejection fraction, a measure of the heart’s ability to pump blood, dropped below 50 percent.

This study is the largest trial on this topic, with 167 sites enrolling 468 patients. The multi-arm, placebo-controlled study explored whether two classes of drugs – ACE inhibitors and beta blockers – preserved a patient’s cardiac function during chemotherapy. The study looked at patients who were treated with Herceptin alone as well as patients who were treated with Herceptin after receiving another chemotherapy drug, doxorubicin.

“These patients are already anxious about their future,” Guglin said. “We don’t want to avoid this exceptionally effective treatment just because it might cause damage to the heart.”

The study's findings

The data showed that neither ACE inhibitors nor beta blockers had an effect on the rate of cardiotoxic events on patients receiving Herceptin alone. However, there was a significant reduction in cardiotoxicity for patients on beta blockers or ACE inhibitors who received doxorubicin before Herceptin.

“The data clearly demonstrated that for patients with HER2-positive breast cancer taking both doxorubicin and Herceptin, adding either an ACE inhibitor or a beta blocker to the treatment regimen can significantly offset the chance of heart problems,” Guglin said.

“In the past few decades, we’ve made huge strides in successfully treating cancers that used to be very deadly for patients.” - Dr. Mark Evers

Studying how to prevent these negative side effects is an important contributor to providing optimal patient care.

“In the past few decades, we’ve made huge strides in successfully treating cancers that used to be very deadly for patients,” said Markey Cancer Center Director Dr. Mark Evers. “It’s important to also think about the patient’s future and to help them maintain the best possible quality of life. This study provides valuable information for oncologists who are treating patients with HER2-positive breast cancer and may help shape the new standard of treatment for this cancer in years to come.”

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