Candesartan is unlikely to mitigate cardiotoxic effects of trastuzumab for patients with early breast cancer, according to a study published in the Journal of the American Medical Association (JAMA) Oncology.1

In an effort to mitigate or prevent cases of left ventricular ejection fraction (LVEF), researchers conducted a randomized, placebo-controlled study, for which 210 (of which 206 were evaluated) women with early breast cancer were enrolled. Each patient was human epidermal growth factor receptor 2 (HER2)-positive.

Of the 103 patients assigned to candesartan (an angiotensin 2 antagonist), 20 had cardiac events, versus 16 in the placebo group. Patients in the candesartan group were also more like to have cardiac events over a 2-year period than those in the placebo group: 0.28 (95% CI, 0.13-0.40) versus 0.16 (95% CI, 0.08-0.22), respectively (P = .56).

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It was found, however, that patients with the Ala1170Pro homozygous ERBB2 genotype were less likely to have a cardiac event (P = .003), indicating a possible marker for identifying those at less risk of these events.

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Despite extremely questionable P-values, the authors concluded that candesartan provided no clinical benefit for patients with early breast cancer undergoing trastuzumab treatment, though the ERBB2-genotype related biomarker may be useful to direct treatment and predict cardiac events in this patient group.


  1. Boekhout AH, Gietema JA, Kerklaan BM, van Werkhoven ED, Altena R, Honkoop A, et al. Angiotensin II–receptor inhibition with candesartan to prevent trastuzumab-related cardiotoxic effects in patients with early breast cancer: a randomized clinical trial [published online ahead of print June 23, 2016]. JAMA Oncol. doi: 10.1001/jamaoncol.2016.1726.