Medicines Found to Protect Heart Health of People Taking HER2-Targeting Therapies
The final day of presentations at the 2018 San Antonio Breast Cancer Symposium included studies about quality of life
, the effect of exercise programs, and easing hot flashes for women on hormonal therapy. One notable study found two medicines used to treat congenital heart failure and other heart problems could be used to prevent heart effects in people taking trastuzumab (Herceptin) and certain chemotherapy medicines.
Beta Blockers, ACE Inhibitors Can Protect Heart During HER2 Treatment
Trastuzumab (Herceptin) is a widely used targeted therapy for HER2-positive breast cancers. It can cause side effects to the heart. Most heart-related side effects are not permanent, but they may cause doctors to lower the dose or stop giving trastuzumab.
Beta blockers and ACE inhibitors, also called angiotensin converting enzyme inhibitors, are two types of medicine that treat heart problems. Both are used often and readily available. Researchers in this study wanted to see if adding these types of medicines to trastuzumab would decrease the chances of heart side effects.
The study had 468 participants with early-stage HER2-positive breast cancer who planned to have chemotherapy and 12 months of trastuzumab. Participants were split based on whether their chemotherapy included an anthracycline, such as doxorubicin (Adriamycin), which can also harm the heart. Everyone was then randomly assigned to one of three study groups to get either a placebo, the beta blocker carvedilol (Coreg) or the ACE inhibitor Lisinopril (Zestril). To find out if the medicines had an effect, researchers measured the ejection fraction, or how much blood leaves the heart each time it contracts.
As a whole, there were no differences in effects on the heart between those who took the placebo and those who got active medicines. But when analyzed by anthracycline use, those who got the medicine had a statistically significant increase in how long they went without any signs of a heart effect.
Based on these results, doctors should consider recommending either lisinopril or carvedilol to people taking trastuzumab and anthracyclines, the researchers said. That statement was reinforced during the Alamo Breast Cancer Foundation’s Hot Topic Mentor Session Friday evening. Debu Tripathy, MD, head of breast medical oncology at University of Texas MD Anderson Cancer Center in Houston, said because these medicines are already available and FDA approved for other conditions, he would start having these conversations with people in his practice on Monday morning.
Approved Therapy Treats Hot Flashes From Hormonal Therapy
In the afternoon, researchers shared results from the ACCRU study SC-1603 of the medicine oxybutynin (Ditropan) to help manage hot flashes. It’s a medicine FDA approved to treat problems with an overactive bladder.
Hot flashes are common in those who have or had breast cancer, especially in people taking anti-estrogen therapy. They can disrupt day-to-day life and sleep, and in some cases cause so much discomfort that people stop taking hormonal therapy. Past research also shows many people hesitate to report these side effects to their doctors. Finding options to lessen hot flashes could improve lives and help people stay on their medicine.
The trial was open to women who had frequent hot flashes, including those taking tamoxifen or aromatase inhibitors. They were assigned to get either a placebo, a 2.5 milligram dose of oxybutynin or 5 milligrams of oxybutynin.
Using oxybutynin led to fewer and less severe hot flashes, the researchers reported. Despite the medicine’s side effects, including dry mouth, abdominal pain, and trouble urinating, most people found them tolerable. Though the researchers didn’t formally test the doses against each other, the 5 milligram dose had a stronger effect and better marks on some quality-of-life measures.
Virginia Kaklamani, MD, leader of the breast cancer program at University of Texas Health San Antonio, discussed this trial at the Alamo Breast Cancer Foundation’s evening Hot Topic session. She noted that those in the 5 milligram arm had an 80 percent decrease in the number of hot flashes, an improvement over the 60 percent reported for other medicines used today to manage this side effect.
“Come Monday morning, if I see a patient with hot flashes, I will talk to my patients about this drug,” Dr. Kaklamani said.
Guided Exercise Program Helps People With Breast Cancer Maintain Heart Fitness
People face a higher risk of heart disease after breast cancer, so researchers behind the EBBA-II trial set out to see if enrolling people with breast cancer to an exercise program would help maintain heart health through treatment.
Participants with DCIS, LCIS, or stage I or II breast cancer were randomly assigned to
- get standard of care, with no additional help with exercise OR
- enroll in a 12-month exercise program
The exercise program featured twice-weekly group sessions with a physiotherapist plus home workouts. (Physiotherapists help people restore, maintain and use their physical strength.) The results were gauged using a measure of oxygen use in an exercise test.
Overall, participants who did the exercise program had better heart fitness than those in the standard of care group. Though both groups had a decline in fitness 6 months after surgery, the decline was less in the exercise group. A year after surgery the exercise group had slightly better fitness, and the control group was still worse than it had been before surgery.
Researchers say these results support offering supervised and tailored exercise programs to people in chemotherapy. During discussion, doctors said the fitness measure is a good sign, but there is still a demand for exercise programs to show an impact on survival.
SUCCESS C Trial Looks at Health Program Effects on Disease-Free Survival
The SUCCESS C trial, also presented Friday morning, looked at whether a fitness program can increase rates of people living without breast cancer returning. Participants were randomly assigned either to a lifestyle program for 2 years based on phone calls and mailings to guide diet, exercise, and health goals such as losing weight, or to a more standard approach of receiving educational mailings about healthy living.
People in the lifestyle program lost a kilogram (about 2.2 pounds) on average in this period, while those in the mailing group gained a kilogram on average, researchers reported. Only 48 percent of people in the fitness group completed the program. There was no difference between the two groups in the rates of cancer recurrence.
The researchers followed participants longer and noted the fitness group had better outcomes: they lost more weight and were less likely to have cancer return. But since this data was found after the study closed, the researchers warned the findings could be biased.
There are many reasons to start or maintain an exercise program. To learn more, talk with your healthcare team about safe first steps to meet your goals.
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