Expert Point of View: Lisa Carey, MD

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Lisa Carey, MD

This study is a nice addition to an emerging literature in cardio-oncology. We need to partner with cardiologists to determine when and how to intervene when using cardiotoxic drugs.

—Lisa Carey, MD

For the most part, the cardiotoxicity with trastuzumab appears to be largely reversible, unlike anthracyclines, which cause permanent cardiac damage,” said Lisa Carey, MD, Distinguished Professor at the UNC Lineberger Breast Center, Chapel Hill, North Carolina.

“In this small study, they saw no congestive heart failure, but the drug had to be withheld in eight patients in the placebo group and one patient each in the bisoprolol and perindopril groups. In clinical practice, we routinely image the heart for patients on trastuzumab, and if we have to hold the drug, we refer the patient to a cardiologist,” she continued.

Support for Prophylaxis

“These data support prophylactic use of a beta-blocker more strongly than an ACE inhibitor. However, there were baseline imbalances; in particular, more patients were taking anthracyclines in the placebo and ACE inhibitor arms than in the beta-blocker arm, so while this suggests that you may prevent asymptomatic ejection fraction declines by prophylactic therapy, this trial cannot be considered definitive.” Dr. Carey noted.

“The truth is we not infrequently have to hold trastuzumab for cardiac issues. Giving cardioprotective drugs may minimize time off trastuzumab, but I wouldn’t change practice based on this small study,” she said.

“This study is a nice addition to the literature. We need cardiologists with an interest in oncology to weigh in, and that is a whole new field that is emerging. I am encouraged that a group of cardiologists are interested in cancer patients. We need to collaborate with cardiologists to define when to intervene and what are expectations are,” concluded Dr. Carey. ■

Disclosure: Dr. Carey reported no potential conflicts of interest.


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The beta-blocker bisoprolol was able to prevent trastuzumab (Herceptin)-associated declines in left-ventricular ejection fraction, whereas the effect of the angiotensin-converting–enzyme (ACE) inhibitor perindopril was less robust. Use of bisoprolol reduced dose interruptions for trastuzumab due to ...