Relationship between changes in left ventricular ejection and use of angiotensin-converting enzyme inhibitors and/or betablockers during adjuvant trastuzumab chemotherapy in early breast cancer: Data from the real world.

Abstract

645 Background: Adjuvant trastuzumab chemotherapy (aTrastC) improves DFS of pts with breast cancer and overexpression of HER-2. However, cardiovascular complication (CV) such as heart failure (HF) or significant left ventricular ejection fraction (LVEF) reduction may appear especially in those pts at increased CV risk. Methods: 253 women treated with aTrastC for EBC in 7 italian oncologic centers during the period 2008-2009 entered in a multicenter registry and were retrospectively studied in 4 subgroups according to the treatment with ACEi and/or BB. Occurrence of symptoms of HF and/or decrease in 10 points % of LVEF were recorded during the follow up. LVEF was measured at baseline and 3-6-9-12 months. Results: Symptoms of HF occurred in 2% of pts who did not take either ACEi/ARB or BB. HF event-rate was similarly increased in pts receiving one or both medications, partially justified by the increased CV risk in these subgroups. Prevalence of decrease in LVEF > 10 points% was similar in all study subgroups. Trends in LVEF were characteristics for each study subgroup: at 3-month evaluation a significant decrease in LVEF was detected in ACEi/ARB and ACEi/ARB + BB group. Multiple logistic regression analysis showed that combined ACEi/ARB + BB therapy depended on history of hypertension (OR 36.7, CI 4.3-315.5) and reduction of LVEF from baseline to 3-month evaluation (OR 0.88, CI 0.78-0.97) (best prediction – 3.5 points %, AUC 0.78, IC 0.65-0.91). Conversely, no association was found between changes in LVEF and ACEi/ARB or BB therapy alone. LVEF recovery from 3 to 12-month evaluation was inversely related to the changes in LVEF from baseline to 3-month evaluation and did not depend on any pharmacological treatment. Conclusions: In clinical practice, a history of hypertension and changes in LVEF during the first 3 months of aTrastC for early breast cancer influence the use of ACEi/ARB and BB. This behaviour may explain the characteristic trend in LVEF showed in the subgroups of patient receiving or receiving not ACEi/ARB or BB. Subsequent recovery of LVEF does not seem to be related to any medical treatment.