A clinical trial to protect the heart during breast cancer treatment

A multicentre prospective randomised open-label blinded end-point controlled trial of high-sensitivity cardiac troponin I-guided combination angiotensin receptor blockade and beta blocker therapy to prevent cardiac toxicity in breast cancer and lymphoma patients receiving anthracycline adjuvant therapy (Joint funding with the EME Programme, an MRC and NIHR partnership)

Dr Peter Henriksen from the University of Edinburgh is leading a clinical trial to find out if commonly used heart failure drugs can protect the heart in women receiving chemotherapy for breast cancer. Breast cancer is common - the lifetime risk of women developing breast cancer in the UK is 1 in 8. Survival continues to improve due in part to the effectiveness of chemotherapy drugs called anthracyclines. But anthracyclines can damage the heart. Because of this, breast cancer survivors have increased rates of heart problems including heart failure. To address this challenge, the BHF, the Medical Research Council (MRC) and the National Institute for Health Research (NIHR) are co-funding a trial testing whether a combination of two drugs - an angiotensin converting enzyme inhibitor (ACEi) and a beta-blocker - can prevent heart muscle injury related to chemotherapy. These drugs are well established treatments for improving symptoms and survival in people with heart failure. The trial will recruit 168 participants across three UK regional cancer centres in Edinburgh, Glasgow and Leeds. Breast cancer patients scheduled for anthracycline treatment will be approached to participate. If they agree, the trial team will test their heart function using an MRI scan prior to starting chemotherapy. Potential participants will also have a blood sample taken to measure the levels of a protein, cardiac troponin I, which is released from the heart into the blood when heart muscle is injured. Patients with increased levels of cardiac troponin I will be allocated at random to treatment with a combination of ACEi and beta-blocker or to standard care (without these drugs). The team will perform a heart MRI scan six months after chemotherapy is completed to see if women taking these drugs have better heart muscle function than those receiving standard care. They will also document how many women in each arm of the trial develop heart failure. This clinical trial will reveal if ACEi and beta-blockers can be used as heart protective therapy in women receiving chemotherapy for breast cancer and will additionally show whether a convenient blood test can detect women at risk of heart failure from chemotherapy.