Abstract 1507P
Background
Trastuzumab (TRA) has significantly improved the outcome of HER2+ breast cancer but is associated with a 0.9% to 4% incidence of TRA-induced cardiotoxicity (TIC). Some previous studies investigated using angiotensin-converting enzyme inhibitors (ACEi) and/or beta-blockers (BB) for prevention of TIC but have yielded conflicting results. We examined our data retrospectively to investigate if ACEi or BB may have cardioprotective effects in breast cancer patients receiving TRA.
Methods
We retrospectively queried breast cancer patients who received TRA at our hospital from 5/2016 to 6/2018. Patients demographics, risk factors for TIC (hypertension, diabetes mellitus and hyperlipidemia), chemotherapy, ACEi and BB use, and echocardiograms were recorded and analyzed. TIC is defined as an absolute drop of left ventricular ejection fraction (LVEF) of 16% or more, or 10-15% drop if the resulting LVEF is below the institutional limit of normal. Fisher’s exact test and Mann-Whitney test were used for analysis.
Results
A total of 188 patients with a median age of 55 were retrieved. 68.6% were Caucasian, 19.1% African American, 6.4% Asian, and 5.9% other/unknown. 7/188 (3.7%) subjects developed TIC. 0/26 patient taking concurrent ACEi developed TIC, compared to 4.5% in patients not taking ACEi (p=0.596). However, this was not statistically significant, likely due to a relatively small sample size. Body mass index, risk factors, concurrent BB use and prior anthracycline exposure between groups were also not significantly different (Table). Table: 1507P
Demographics of patients with versus without TIC
| Patients with no TIC | Patients with TIC | P value | |
| Total number | 181 | 7 | |
| Body Mass Index | 26.8 (23.8-31.0) | 24.2 (22.9-35.0) | 0.624 |
| Anthracycline exposure | 15 (8.3%) | 0 (0%) | 1.000 |
| Hypertension | 35 (19.3%) | 1 (14.3%) | 1.000 |
| Hyperlipidemia | 13 (7.2%) | 1 (14.3%) | 0.424 |
| Diabetes mellitus | 11 (6.1%) | 0 (0%) | 1.000 |
| ACEi | 26 (14.4%) | 0 (0%) | 0.596 |
| BB | 62 (34.3%) | 3 (42.8%) | 0.694 |
Conclusions
In our retrospective study, none of the patients receiving TRA and concurrent ACEi developed TIC, as compared to 4.5% developing TIC in those who were not taking ACEi. Our data suggests that ACEi may be cardioprotective in breast cancer patients receiving TRA. However, larger prospective studies are needed to clarify the potential benefit of ACEi.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.