Carvedilol (Coreg) may reduce risk for diastolic dysfunction if given during anthracycline treatment for breast cancer.
Why this matters
- Previous studies of beta-blockade as primary prevention for anthracycline-related cardiotoxicity have had important limitations.
- The PRADA trial found no benefit for metoprolol (Lopressor), but carvedilol has different properties.
- CECCY, a prospective, double-blind study that evaluated 192 patients with HER-2-negative breast cancer and normal left ventricular ejection fraction (LVEF), referred for anthracycline (240 mg/m2) chemotherapy.
- Patients randomly allocated to either carvedilol or placebo until chemotherapy completion.
- Carvedilol/placebo were initially administered at 3.125 mg twice daily, progressively increased to a maximum of 25 mg/12 hours.
- Funding: São Paulo Research Foundation.
- Incidence of diastolic function was lower in carvedilol vs placebo group (P=.039).
- Troponin I levels decreased over time in the carvedilol group (P=.003).
- 14.5% vs 13.5% patients in carvedilol vs placebo group had ≥10% reduction in LVEF at 6 months (P=1.0).
- No difference across groups was observed for brain natriuretic peptide (P=.85).
- Few cases of lowered LVEF reduced analytic power.
- Cases of diastolic dysfunction were mostly low-grade.
- Short follow-up period.
Coauthored with Antara Ghosh, PhD