Evaluation of the Preventive Effects of Carvedilol on Trastuzumab-Induced Cardiotoxicity in Early-Stage and Locally Advanced HER2-Positive Breast Cancer Patients

Mohsen Esfandbod; Mina Naderi; Azadeh Sadatnaseri; Ayat Ahmadi; Mohammadtaghi Noroozi; Saeid Sadeghi Joni

doi:10.18502/ijhoscr.v15i4.7475

Mohsen Esfandbod Department of Clinical Hematology and Bone Marrow Transplantation, Vali-e-Asr Hospital, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Mina Naderi Department of Internal Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
Azadeh Sadatnaseri Department of Cardiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
Ayat Ahmadi Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
Mohammadtaghi Noroozi Department of Internal Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
Saeid Sadeghi Joni Department of Radiology, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran

DOI: https://doi.org/10.18502/ijhoscr.v15i4.7475

Keywords: Trastuzumab-induced cardiotoxicity; Carvedilol; Human epidermal growth factor receptor-2 (HER-2); Ejection fraction; Pulmonary artery pressure

Abstract

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.