Carvedilol did not significantly prevent trastuzumab-induced cardiotoxicity in HER2-positive breast cancer, with EF decrease in 23.3% of carvedilol patients versus 6.7% of controls (p=0.07).
RCT (n=60)
Single-blind
Simple randomization
No
Does carvedilol prevent trastuzumab-induced cardiotoxicity (ejection fraction decline and pulmonary artery pressure increase) in patients with early-stage and locally advanced HER2-positive breast cancer?
Carvedilol did not demonstrate a significant protective effect against trastuzumab-induced cardiotoxicity (LVEF decline or PAP increase) in patients with HER2-positive breast cancer.
Absolute Event Rate: 23.3% vs 6.7%
p-value: p=0.07
Background: Trastuzumab is an efficient monoclonal antibody used in the treatment of Her2-positive breast cancer. Despite its prominent effect on Her2-positive patients’ disease-free Survival. Trastuzumab-induced cardiotoxicity is still one of the main challenges. Angiotensin-converting enzyme inhibitors (ACE inhibitors) are one of the most potent agents used in heart failure, which also showed confirmed cardioprotective effects against anthracycline and doxorubicin. We aimed to assess the cardioprotective effects of Carvedilol in a randomized clinical trial study. Materials and Methods: sixty non-metastatic Her-2 positive patients (30 cases; 30 controls) were entered into the study via a simple randomization method.Carvedilol was administered for the patients with the starting dose of 3.125 mg twice a day and started 7 days before trastuzumab administration. The dose has been increased in a three-week period to reach 12.5 mg twice a day and continued until the end of therapy. All the patients underwent an echocardiography after receiving Adriamycin and Cyclophosphamide in order to measure basal Ejection Fraction (EF) and Pulmonary Artery Pressure (PAP). Each patient underwent a follow-up echocardiography in 3,6,9 and 12 months after initiation of the treatment. Finally, all the patients went through the last episode of echocardiography 1 month after the end of treatment. All the Measured PAP and EF has been recorded and analyzed Results: EF and PAP changes for both groups had no significant changes during the course of treatment with Trastuzmab (p-value = 0.628 and p-value = 0.723, respectively). Seven patients in the intervention group and 2 patients in the control group presented with EF decrease. Also, 8 patients in the intervention and 9 patients in the control groups showed PAP increase. Conclusion: According to our results, in patients with HER2-positive breast cancer treated with trastuzumab, Carvedilol showed no significant protective effect on trastuzumab-induced cardiotoxicity.
Esfandbod et al. (Sun,) conducted a rct in HER2-positive breast cancer (n=60). Carvedilol vs. Control (standard care) was evaluated on Ejection Fraction (EF) decrease (p=0.07). Carvedilol did not significantly prevent trastuzumab-induced cardiotoxicity in HER2-positive breast cancer, with EF decrease in 23.3% of carvedilol patients versus 6.7% of controls (p=0.07).