Abstract 13988: Cardioprotective Effect of Beta-Blockers and ACE-Inhibitors in Breast Cancer Patients Treated with Trastuzumab: A Follow-Up Study of Heart Failure and Cardiac Function Over 12 Months
Background: Cardiotoxicity is a potential complication of trastuzumab (TSZB) and anthracyclines in breast cancer therapy. We sought whether cardioprotection with Beta-Blockers (BB) and ACE-Inhibitors (ACEI) reduced the one- year incidence of cardiotoxicity.
Methods: We analyzed prospectively entered data into the electronic medical record on a consecutive cohort of 197 pts without prior HF receiving TSZB with or without prior anthracycline treatment from 2005-2010, who underwent baseline and follow-up echo. A propensity score model (including hypertension, diabetes, cardiac history, age and selected interactions) to predict use of either ACEI or BB at the start of chemotherapy was developed in an independent sample of 1808 similar breast cancer pts, ineligible for the main study. The score was applied to the study group to account for potential indication bias. A composite outcome of LVD was defined by left ventricular dysfunction (LVD, 10% decline in EF from baseline, EF < 55%) and new diagnosis of heart failure (HF).
Results: During the 12 months of TSZB treatment, 14 pts developed new diagnoses of HF and 72 developed LVD. The protective effect of BB (n = 30) and ACEI (n = 22) prior to TSZB was assessed at baseline (n = 145) and adjusted for propensity for treatment and covariates. Evidence of LVD was identified in fewer patients on prophylactic BB while new CHF was found only among those without BB (Table). Logistic regression indicated a protective effect of BB but not ACEI using the composite outcome (OR = 0.17, 95% C.I. 0.05-0.62, p = .007). Current smokers (p = .038) were at significant higher risk for LVD. Prior treatment with anthracyclines (up to four cycles) or other chemotherapy prior to treatment with TSZB was not predictive (p < .10).
- © 2011 by American Heart Association, Inc.