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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

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. Metho...

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Autores principales: Geuna, Elena, Lombardi, Pasquale, Martinello, Rossella, Garino, Davide, Bonzano, Alessandro, Galizia, Danilo, Nuzzo, Annamaria, Berchialla, Paola, Becco, Paolo, Mangioni, Monica, De Zarlo, Lorena, Montemurro, Filippo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7072182/
https://www.ncbi.nlm.nih.gov/pubmed/32023877
http://dx.doi.org/10.3390/cancers12020327
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author Geuna, Elena
Lombardi, Pasquale
Martinello, Rossella
Garino, Davide
Bonzano, Alessandro
Galizia, Danilo
Nuzzo, Annamaria
Berchialla, Paola
Becco, Paolo
Mangioni, Monica
De Zarlo, Lorena
Montemurro, Filippo
author_facet Geuna, Elena
Lombardi, Pasquale
Martinello, Rossella
Garino, Davide
Bonzano, Alessandro
Galizia, Danilo
Nuzzo, Annamaria
Berchialla, Paola
Becco, Paolo
Mangioni, Monica
De Zarlo, Lorena
Montemurro, Filippo
author_sort Geuna, Elena
collection PubMed
description 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.
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spelling pubmed-70721822020-03-19 Treatment with Beta-Blockers and ACE-Inhibitors in Breast Cancer Patients Receiving Adjuvant Trastuzumab-Based Therapy and Developing Mild Cardiac Toxicity: A Prospective Study Geuna, Elena Lombardi, Pasquale Martinello, Rossella Garino, Davide Bonzano, Alessandro Galizia, Danilo Nuzzo, Annamaria Berchialla, Paola Becco, Paolo Mangioni, Monica De Zarlo, Lorena Montemurro, Filippo Cancers (Basel) Article 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. MDPI 2020-01-31 /pmc/articles/PMC7072182/ /pubmed/32023877 http://dx.doi.org/10.3390/cancers12020327 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Geuna, Elena
Lombardi, Pasquale
Martinello, Rossella
Garino, Davide
Bonzano, Alessandro
Galizia, Danilo
Nuzzo, Annamaria
Berchialla, Paola
Becco, Paolo
Mangioni, Monica
De Zarlo, Lorena
Montemurro, Filippo
Treatment with Beta-Blockers and ACE-Inhibitors in Breast Cancer Patients Receiving Adjuvant Trastuzumab-Based Therapy and Developing Mild Cardiac Toxicity: A Prospective Study
title Treatment with Beta-Blockers and ACE-Inhibitors in Breast Cancer Patients Receiving Adjuvant Trastuzumab-Based Therapy and Developing Mild Cardiac Toxicity: A Prospective Study
title_full Treatment with Beta-Blockers and ACE-Inhibitors in Breast Cancer Patients Receiving Adjuvant Trastuzumab-Based Therapy and Developing Mild Cardiac Toxicity: A Prospective Study
title_fullStr Treatment with Beta-Blockers and ACE-Inhibitors in Breast Cancer Patients Receiving Adjuvant Trastuzumab-Based Therapy and Developing Mild Cardiac Toxicity: A Prospective Study
title_full_unstemmed Treatment with Beta-Blockers and ACE-Inhibitors in Breast Cancer Patients Receiving Adjuvant Trastuzumab-Based Therapy and Developing Mild Cardiac Toxicity: A Prospective Study
title_short Treatment with Beta-Blockers and ACE-Inhibitors in Breast Cancer Patients Receiving Adjuvant Trastuzumab-Based Therapy and Developing Mild Cardiac Toxicity: A Prospective Study
title_sort treatment with beta-blockers and ace-inhibitors in breast cancer patients receiving adjuvant trastuzumab-based therapy and developing mild cardiac toxicity: a prospective study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7072182/
https://www.ncbi.nlm.nih.gov/pubmed/32023877
http://dx.doi.org/10.3390/cancers12020327
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