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Thursday, February 29, 2024
Feb. 29, 2024

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Breast cancer patients may skirt risk to heart


For years, breast cancer patients on the chemotherapy drug regimen of doxorubicin and Herceptin have risked heart damage.

A University of Kentucky cardiologist thinks that for some of those patients, there’s a solution.

Dr. Maya Guglin of the UK Gill Heart & Vascular Institute recently presented data from a major clinical trial on the effectiveness of two drugs used to treat heart problems resulting from those chemo drugs.

Her presentation was given at the the American College of Cardiology’s scientific session in Orlando.

Drug trial participants, which included 467 female and one male participant, had been treated with Herceptin and the anthracycline chemotherapy drug doxorubicin (known to some patients as “red devil”), or Herceptin only.

Each group was given either a placebo, the ACE inhibitor Lisinopril (used to treat high blood pressure and congestive heart failure) or beta blocker carvedilol (used to control heart rhythm, angina and high blood pressure).

Among patients given ace inhibitors or beta blockers along with a treatment including Herceptin and doxirubicin, the number of cardiac reactions were significantly lower than those in the placebo group.

That means that more patients can stay on the chemotherapy drugs longer, and presumably, that future cancers can be prevented.

The practice of pairing Herceptin with a heart drug has been used in some practices for the last few years. The trial data presented by Guglin provides additional credibility to the success of combination of Herceptin with a beta blocker or ace inhibitor in a regimen that has also included doxyrubicin.

Herceptin “is such an important anti-cancer drug … and we also want to decrease anxiety, we want women to feel protected,” Guglin said.

Dr. Mara Chambers, an oncologist at UK’s Markey Cancer Center, said that combining Herceptin with ace inhibitors or beta blockers “absolutely helps us” to use the anti-cancer drug in breast cancer patients for as long as possible.

“Certainly there’s enough data that it’s becoming more of a practice to do that,” she said.

Breast cancer treatment has long veered between aggression and caution: aggressive treatment to rid the patient of the cancer, and caution when aggressive treatment has serious side effects such as heart damage.

Herceptin was introduced in 1998 to treat an aggressive form of breast cancer called HER2-positive. About one in four patients developed potentially dangerous heart problems while taking it. That led to patients being discontinued from Herceptin treatment, which physicians including the University of Kentucky Markey Cancer Center’s Edward Romond strongly championed for its effectiveness in reducing the risk of cancer recurrence.

Heart damage triggered by Herceptin is usually reversible, but the patient had to stop taking Herceptin.

Although not part of the trial, Lexingtonian Lucy King, 61, has had breast cancer three times. In 1996, a mastectomy of her left breast; in 2006, a lumpectomy, chemotherapy and radiation on her right side; and a diagnosis in February, 2017, that the cancer was back in her right breast.

King, a first-grade teacher, is on Herceptin now, as well as the beta blocker Coreg. Although she is frequently fatigued, she is looking forward to working out again.

“Hopefully, nothing will ever happen again,” King said.