Heart medication can be prescribed for patients with early-stage breast cancer undergoing chemotherapy with treatments like Herceptin (trastuzumab) to prevent cardiac damage and failure associated with this treatment, according to the results of a clinical trial.
This study, “Multidisciplinary Approach To Novel Therapies In Cardio-Oncology Research (MANTICORE 101–Breast): A Randomized Trial For The Prevention Of Trastuzumab-Associated Cardiotoxicity,” was published in The Journal of Clinical Oncology.
Patients with early-stage breast cancer often are treated with chemotherapies like Herceptin, which target the HER-2 gene and greatly improve survival. But these treatments may increase the risk of heart failure by five times, a condition that is as serious as cancer itself.
To analyze whether heart medication could be given in combination with Herceptin to patients, researchers in Canada developed the MANTICORE trial (NCT01016886), which enrolled patients with HER2-positive early breast cancer who were randomly assigned to receive either treatment with heart medications perindopril (an ACE inhibitor, 33 patients), bisoprolol (a beta blocker, 31 patients), or a placebo (30 patients).
The treatments were administered in combination with Herceptin for one year. The study was funded by the Canadian Institutes of Health Research (CIHR) and the Alberta Cancer Foundation.
Patients were evaluated by cardiac magnetic resonance imaging (MRI) at the study’s start and after 17 cycles of drug therapy to assess left ventricular volumes and left ventricular ejection fraction (LVEF). Cardiotoxicity was evaluated as the change in indexed left ventricular end diastolic volume and LVEF (measurement of heart weakening).
Results showed that patients who received the beta blocker and ACE inhibitor showed fewer signs of heart damage induced by the cancer treatment than those in the placebo group.
“We think this is practice-changing,” Edith Pituskin, RN, PhD, first author of the study, said in a press release. “This will improve the safety of the cancer treatment that we provide.”
According to Ian Paterson, MD, the study’s senior author, chemotherapy is interrupted when patients show signs of heart complications and only resumed when heart function returns to normal. However, these results show that heart medications can protect not only the heart from the toxic effects induced by Perception, but also improve survival rates among patients because they can complete their cancer treatment.
“We are aiming for two outcomes for these patients — we’re hoping to prevent heart failure and we’re hoping for them to receive all the chemotherapy that they are meant to get, when they are supposed to get it — to improve their odds of remission and survival,” Paterson said.
Brenda Skanes was one of the participants of the trial. Her family has a history of cardiac problems (her mother died of a stroke and her father had a heart attack).
“I met survivors through my journey who experienced heart complications caused by Herceptin,” she said. “If they had access to this, maybe they wouldn’t have those conditions now.”
“Me participating, it’s for the other survivors who are just going into treatment,” she added.
Another participant of the study, Debbie Cameron, also said she would do anything to prevent other patients from experiencing similar problems.
“My daughters are always in the back of my mind and the what-ifs — if they’re diagnosed, what would make their treatment safer, better,” she said. “Anything I could do to make this easier for anybody else or give some insight to treatment down the road was, to me, a very easy decision.”
“We couldn’t be more pleased with this return on our investment,” said Myka Osinchuk, CEO of the Alberta Cancer Foundation. “This clinical research will improve treatment and make life better not only for Albertans facing cancer, but also for those around the world.”