High-Sensitivity Cardiac Troponin I-Guided Combination Angiotensin Receptor Blockade and Beta-Blocker Therapy to Prevent Cardiac Toxicity in Cancer Patients Receiving Anthracycline Chemotherapy - Cardiac CARE
Contribution To Literature:
The Cardiac CARE trial failed to show that cardio-protection with beta-blocker/angiotensin receptor blocker prevents left ventricular systolic dysfunction.
Description:
The goal of the trial was to evaluate cardio-protection (beta-blocker/angiotensin receptor blocker) compared with standard of care among patients with a high risk of cardiotoxicity after anthracycline chemotherapy.
Study Design
- Randomized
- Parallel
- Blinded
- Open-label
Patients with a high risk of cardiotoxicity after anthracycline chemotherapy were randomized to cardio-protection (n = 29) vs. standard of care (n = 28) (nonrandomized, n = 118). Cardiotoxicity was defined as elevation in cardiac enzyme (troponin I). Cardio-protection was defined as combined use of carvedilol plus candesartan.
- Total number of enrollees: 175
- Duration of follow-up: 6 months
- Mean patient age: 54 years
- Percentage female: 79%
- Percentage with diabetes: 0%
Inclusion criteria:
- Patients ≥18 years of age with breast cancer or non-Hodgkin’s lymphoma undergoing anthracycline chemotherapy
- Elevation in troponin I >upper tertile
- Left ventricular ejection fraction (LVEF) ≥50%
Exclusion criteria:
- Human epidermal growth factor receptor 2-positive breast cancer
- Lower-dose anthracycline regimen
- Ongoing treatment with angiotensin receptor blockers, angiotensin-converting enzyme inhibitors, or beta-blockers
- Hypotension or hypertension
- Previous anthracycline chemotherapy
Principal Findings:
The primary outcome, adjusted change in LVEF from baseline to 6 months, was −1.3% in the cardio-protection group vs. −0.9% in the standard of care group (p = 0.82).
Secondary outcomes:
- Any adverse event: 71.4% with cardio-protection vs. 10.3% with standard of care
Interpretation:
Among patients undergoing treatment with anthracycline chemotherapy with signs of cardiotoxicity, cardio-protection with combined beta-blocker/angiotensin receptor blocker failed to prevent left ventricular systolic dysfunction.
References:
Henriksen PA, Hall P, MacPherson IR, et al. Multicenter, Prospective, Randomized Controlled Trial of High-Sensitivity Cardiac Troponin I–Guided Combination Angiotensin Receptor Blockade and Beta-Blocker Therapy to Prevent Anthracycline Cardiotoxicity: The Cardiac CARE Trial. Circulation 2023;Sep 25:[Epub ahead of print].
Clinical Topics: Cardio-Oncology, Heart Failure and Cardiac Biomarkers
Keywords: Cardiotoxicity, Troponin I
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