Trastuzumab taken with carvedilol leads to less heart damage

A study has shown that breast cancer patients who take a heart drug along with trastuzumab have less heart damage.

“Heart damage is a major side effect of the breast cancer drug trastuzumab and may force patients to stop treatment,” said lead author Dr Maryam Moshkani Farahani, Associate Professor, Baqiyatallah University of Medical Sciences, Tehran, Iran. “Our study suggests that patients who take the beta-blocker carvedilol together with trastuzumab have less heart damage than those who take trastuzumab alone.”

The study looked at 71 patients with non-metastatic HER-2 positive breast cancer who were randomly given trastuzumab either with, or without, carvedilol. Trastuzumab usually causes impaired function of the heart’s left ventricle, with carvedilol being used to treat patients with this type of damage after a heart attack. The drug can also be prescribed for patients with heart failure and high blood pressure. 

Two-dimensional speckle tracking echocardiography was used by the researchers to assess the systolic and diastolic function of the left ventricle initially and after three months. Systolic function was measured using global longitudinal strain and strain rate, while diastolic function was assessed with strain rate. The researchers mentioned how after three months, patients who were taking carvedilol with trastuzumab had better preserved systolic and diastolic left ventricular function, in comparison to those only taking trastuzumab.

“The measures we used to assess left ventricular function – namely global longitudinal strain and strain rate – are more sensitive than left ventricular ejection fraction,” explained Dr Moshkani Farahani.

She concluded: “The findings indicate that carvedilol may be an effective way to prevent the heart damage caused by trastuzumab treatment. 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.”

The study was presented at EuroEcho-Imaging 2018.