Print Share Email Send Email Your Name (required) ! Example: John Doe Email Address (required) ! Error: Please enter a valid sender email address. Example: email@example.com CC Me Recipient Email Address (required) ! Separate multiple email address with semi-colons (up to 5). Subject Subject for your email. Message (Maximum characters: 1,000) Error: Please enter your name Error: Please enter your email address Error: Please enter a valid recipient email address. Example:firstname.lastname@example.org Thank you! Your email has been sent to: The recipient(s) will receive an email message that includes a link to the selected article. Recipients may need to check their spam filters or confirm that the address is safe. Return to: Send Another Email An error has occurred sending your email(s). Please try again later or contact an administrator at OnlineCustomer_Service@email.mheducation.com. Return to: Twitter Facebook Linkedin Reddit Get Citation Citation AMA Citation Michelis K, Lala A. Michelis K, Lala A Michelis, Katherine, and Anuradha Lala. "Lisinopril or Carvedilol for Prevention of Trastuzumab Induced Cardiotoxicity." Hurst's the Heart Updates, 24 May 2016. McGraw-Hill, New York, NY, 2016. AccessCardiology. http://accesscardiology.mhmedical.com/updatesContent.aspx?gbosid=424346§ionid=189592028 MLA Citation Michelis K, Lala A. Michelis K, Lala A Michelis, Katherine, and Anuradha Lala.. "Lisinopril or Carvedilol for Prevention of Trastuzumab Induced Cardiotoxicity." Hurst's the Heart Updates Fuster V. Fuster V Fuster, Valentin. New York, NY: McGraw-Hill, 2016, http://accesscardiology.mhmedical.com/updatesContent.aspx?gbosid=424346§ionid=189592028. Download citation file: RIS (Zotero) EndNote BibTex Medlars ProCite RefWorks Reference Manager Mendeley © Copyright Tools Clip Full Chapter Figures Only Tables Only Videos Only Supplementary Content Top Lisinopril or Carvedilol for Prevention of Trastuzumab Induced Cardiotoxicity by Katherine Michelis, MD; Anuradha Lala, MD, + +Update to Chapter 101: The Diagnosis and Management of Cardiovascular Disease in Patients with Cancer Study Summary + +This multicenter, randomized, placebo-controlled trial evaluated whether the administration of either the angiotensin-converting enzyme (ACE) inhibitor lisinopril or the cardiospecific β-blocker carvedilol prevented cardiotoxicity in 468 patients with HER2+ breast cancer and normal left ventricular (LV) function at baseline who were treated with adjuvant trastuzumab, with or without anthracyclines. Rates of cardiotoxicity — defined as an absolute decrease in LV ejection fraction (LVEF) of ≥10% or a decrease of ≥5% to an LVEF of <50% — were similar in trastuzumab-alone treated HER2+ breast cancer patients across the three arms with 32% observed in the placebo group, 29% in the carvedilol group and 30% in the lisinopril group. There was no difference in the number of treatment interruptions. In patients treated with both trastuzumab and an anthracycline, however, lisinopril and carvedilol were each associated with reduced rates of cardiotoxicity compared to placebo (lisinopril: HR 0.53, 95% CI 0.30, 0.94, p = 0.015; carvedilol: HR 0.49, 95% CI 0.27, 0.89, p = 0.009) (see accompanying Hurst’s Central Illustration). + Reduction of Cardiotoxicity Associated with Trastuzumab and Anthracycline Graphic Jump LocationView Full Size|Favorite Figure|Download Slide (.ppt) Commentary + +Study Strengths: This study attempts to fill an important knowledge gap in cardio-oncology in a randomized, double blinded trial conducted across multiple centers. In trastuzumab-alone treated HER2+ breast cancer patients, the incidence of cardiotoxicity is approximately 30%, uninfluenced by prophylactic treatment with a beta blocker or ACE inhibitor over one year. The increased incidence to 47% in those who are concomitantly treated with an anthracycline is mitigated by treatment with either an ACE inhibitor or carvedilol. +Study Limitations: It is well known that patients at highest risk for trastuzumab-related cardiac dysfunction are those treated with concomitantly with anthracyclines. It was in this subgroup of trial patients that both lisinopril and carvedilol individually were effective in preventing the cardiotoxic side effect of worsening LV function. The follow up period of only 1 year is relatively limited, not allowing for conclusions over a longer follow up about the potential for reversibility of cardiotoxicity. +Next Steps/Clinical Perspective: It is possible that pre-treatment with both ACE inhibitor and beta blocker, as is standard of care for the treatment of both asymptomatic and symptomatic LV dysfunction, may lead to the most benefit in patients with trastuzamab-related cardiac dysfunction treated concomitantly with anthracyclines. Such an approach with dual treatment warrants further study. Additionally, it would be worthwhile to investigate further whether cardiotoxicity associated with other chemotherapeutic agents, such as 5-fluoruracil, could be avoided by targeted cardioprotective medications.