Administration of angiotensin-converting enzyme inhibitors and β-blockers during adjuvant trastuzumab chemotherapy for nonmetastatic breast cancer: marker of risk or cardioprotection in the real world Full Text
The Oncologist, 07/20/2012
Oliva S et al. – In clinical practice, the degree of hypertension and decrease in left ventricular ejection fraction (LVEF) during the first 3 months of adjuvant trastuzumab therapy for EBC are associated with the use of ACEi/ARBs and β–blockers. The combined use of these two medications is associated with a recovery of LVEF during months 3–12 of adjuvant trastuzumab therapy.Methods
- A total of 499 women receiving adjuvant trastuzumab therapy for EBC entered in a multicenter registry and were divided into four subgroups according to treatment with ACEi/ARBs and/or β–blockers.
- Occurrence of HF and decrease of left ventricular ejection fraction (LVEF; minimum 10 percentage points) were recorded.
- HF occurred in 2% of patients who did not take either ACEi/ARBs or β–blockers, 8% of patients receiving ACEi/ARBs alone, 8% receiving β–blockers alone (p = .03), and 19% receiving both medications (p < .01).
- The prevalence of patients with LVEF that decreased by at least 10 percentage points was similar in all groups.
- Combined ACEi/ARBs and β–blocker therapy was independently associated with hypertension and a significant reduction of LVEF from baseline to 3–month evaluation.
- The use of ACEi/ARBs alone or β–blockers alone was predicted only by hypertension.
- Combined therapy of ACEi/ARBs plus β–blockers predicted LVEF recovery from the 3–month to 12–month evaluation.