Combo of trastuzumab, carvedilol cuts risk of heart damage in breast cancer patients

Data presented at the 2018 EuroEcho-Imaging congress in Milan suggest breast cancer patients who take the common chemo drug trastuzumab might be able to mitigate their risk of heart damage by supplementing with carvedilol, a beta-blocker used predominantly by cardiac patients.

Trastuzumab, sold under the brand name Herceptin, is often the drug of choice for treating patients with HER2-positive breast cancer, Maryam Moshkani Farahani, lead study author and an associate professor at Baqiyatallah University of Medical Sciences in Tehran, Iran, said. But it’s also been linked to impaired left ventricular function in the patients who take it.

“Heart damage is a major side effect of the breast cancer drug trastuzumab and may force patients to stop treatment,” Moshkani Farahani said in a release. “Our study suggests that patients who take the beta-blocker carvedilol together with trastuzumab have less heart damage than those who take trastuzumab alone.”

Moshkani Farahani and her team randomized 71 patients with non-metastatic HER2-positive breast cancer to treatment with trastuzumab and carvedilol or trastuzumab on its own. The researchers employed two-dimensional speckle tracking echocardiography to assess participants’ systolic and diastolic function first at the study’s baseline and again at three months.

Patients’ global longitudinal strain and strain rate data suggested both systolic and diastolic function were better preserved at three months when they took the combo of drugs rather than trastuzumab alone. Moshkani Farahani said left ventricular ejection fraction didn’t differ between treatment groups at any point.

“The findings indicate that carvedilol may be an effective way to prevent the heart damage caused by trastuzumab treatment,” she said. “We now advise our patients with non-metastatic HER2-positive breast cancer to take prophylactic carvedilol, but a larger study is needed before firm recommendations can be made.”