P082 CBCSG-10, the addition of capecitabine to adjuvant chemotherapy in triple-negative breast cancer

Abstract

benefit of these agents is ill-defined in HER2-positive breast cancer patients with known cardiac-related comorbidities given trastuzumab. We sought to determine if being on these medications when given trastuzumab prevents decline in LVEF in patients with known cardiac-related comorbidities. Methods: Adhered to the PRISMA statement for pooled-analysis. Selection criteria: Clinical trials involving patient cohorts already on cardioprotective medications when treated with trastuzumab. Search strategy: PubMed, the Cochrane Library, Google Scholar, Web of Science, and Scopus databases from 1998 to 2013, plus www.asco.org and www.clinicaltrials.gov. Outcome measure: Decline in LVEF >10% of baseline per ECHO or MUGA while on b-blocker +/− ACEi or ARB, plus trastuzumab. Statistical analysis: Dedicated pooled-analysis statistical software (BioStat Inc., NJ, USA). Results: From 218 articles, 6 clinical trials (n = 329) were selected with extractable data. Patients on b-blocker +/− ACEi or ARB tended to be older and heavily pretreated with chemotherapy. Being on cardioprotective medications during trastuzumab therapy was beneficial for stability of LVEF in patients at above-average risk for cardiotoxicity [mean odds ratio (OR): 0.664, 95%CI 0.44 to 1.01; random effects model p = 0.05 versus fixed effect model p = 0.004]. Statistical analyses revealed robustness of our analysis for comorbidity index (p < 0.05). Conclusion: This hypothesis-generating analysis suggests that use of b-blocker +/− ACEi or ARB during trastuzumab therapy prevents decline in LVEF in breast cancer patients with known cardiac risk factors or co-morbidities. Disclosure of Interest: No significant relationships.