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).
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.
- 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.