ACE inhibitors and beta-blockers reduce risk of cardiotoxicity for some Herceptin patients

Researchers conclude that prophylactic use of lisinopril or carvedilol should be considered in patients who could benefit from anthracycline treatment prior to trastuzumab (Herceptin).

Lisinopril ACE inhibitor, molecular structure

Trastuzumab (Herceptin; Genentech) is an effective treatment for HER2-positive breast cancer but it is frequently associated with cardiac side effects.

In research presented at the American College of Cardiology’s Annual Scientific Session in Orlando, Florida (11 March 2018), researchers analysed data on 468 patients treated with trastuzumab who were randomly assigned to receive lisinopril (an ACE inhibitor), carvedilol (a beta-blocker) or placebo[1]
. Patients were stratified by treatment with an anthracycline, such as doxorubicin.

The data showed no significant difference overall in rates of cardiotoxicity between the three groups. However, during the two-year follow up, among patients who received an anthracycline alongside trastuzumab, cardiac prophylaxis decreased the rate of cardiotoxicity by around 50%.

The team said the results indicated that prophylactic use of lisinopril or carvedilol should be considered in those patients who could benefit from anthracycline treatment prior to trastuzumab.

References

[1] Guglin M, Krischer J, Tamura R et al. Lisinopril or carvediol for prevention of trastuzumab-induced cardiotoxicity. Presented at: American College of Cardiology Annual Scientific Session; 10–12 March 2018; Orlando, Florida. Abstract available here: http://www.acc.org/latest-in-cardiology/clinical-trials/2018/03/10/15/11/lisinopril-or-carvedilol-for-cardiotoxicity

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Citation
Clinical Pharmacist, CP, June 2018, Vol 10, No 6;10(6):DOI:10.1211/PJ.2018.20204705