Lisinopril versus carvedilol to prevent trastuzumab-related heart problems in patients with breast cancer.

This study wanted to find out if lisinopril (Zestril) or carvedilol (Coreg) can help prevent heart problems in patients with HER2 positive breast cancer who are treated with trastuzumab (Herceptin). The study found that both of these medications helped reduce the chance of heart problems in these patients if they were also being treated with anthracyclines.

HER-2 positive breast cancer is a type of cancer where the cells have a molecule on them for the human epidermal growth factor 2 (HER-2). This molecule fuels cancer cell growth. Cancers sensitive for this molecule (HER-2+) usually respond to medications that target HER-2.

A medication which targets the HER-2+ cells is called trastuzumab. This medication has good outcomes in treating HER-2+ breast cancers. However, a common side effect of this medication is heart problems. Lisinopril and carvedilol are medications used to treat heart problems. It is not known if treating patients with these medications during their treatment with trastuzumab will decrease the chance of heart problems. It is also not known which heart medication will work best.

This study has 468 patients. All the patients had HER2+ breast cancer. All the patients were treated with trastuzumab for 12 months. Some of the patients were treated with a type of chemotherapy medication called anthracyclines. The patients were split into three groups. Group one had 156 patients, who were all treated with carvedilol. Group two had 158 patients, who were all treated with lisinopril. Group 3 had 154 patients, who took a placebo medication. The patients were followed for 2 years.

After 12 months, the risk of having heart problems was almost equal across all three groups. 32% of patients on placebo, 29% on carvedilol, and 30% on lisinopril had heart problems.

In patients who were also treated with anthracyclines, 47% of patients on placebo, 37% on lisinopril and 31% on carvedilol had heart problems. Patients on carvedilol had a 51% higher likelihood of living without heart problems compared to placebo. Patients on lisinopril also had a 47% higher likelihood of living without heart problems compared to placebo.

The study concluded that for patients with HER2 positive breast cancer taking trastuzumab and anthracyclines, both lisinopril and carvedilol were beneficial in preventing heart problems.

This was a small study. A number of patients had to drop out during the study. More research is needed.