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. 2021 Oct 8;23(Suppl E):E28–E32. doi: 10.1093/eurheartj/suab085

Table 1.

Summary of trials mod from Brown et al.16

Cancer treatment Primary end point n Medication Follow up Results Conclusion
Avila (CECCY) 2018 Trastuzumab EF decline >10% 200 Carvedilolo (3.125 mg twice a day → 25 mg twice a day) 6 months No difference from placebo (13.5% vs. 14.5%) No benefit
Boekhout 2016 Trastuzumab EF decline of more than 15% or a decrease below 45% 206 Candesartan (16–32 mg) 2 months Candesartan had higher incidence of cardiac events vs. placebo (0.28 vs. 0.16 P = NS) No benefit, possible harm
Bosch (OVERCOME) 2013 Anthracycline Absolute change from baseline in EF by ECHO and CMR 90

  • Enalapril

  • (2.5 mg twice a day → 10 mg twice a day) + Carvedilol

  • (6.25 mg twice a day → 25 mg twice a day)

 6 months EF unchanged with enalapril and carvedilol vs. −3.1% (ECHO) and −3.4% (CMR) with placebo Benefit
Cardinale 2006 Anthracycline EF decrease >10% 114 Enalapril (5–20 mg) 12 months 0 vs. 43% P < 0.001 Benefit
Guglin 2019

  • Trastuzumab only

  • Trastuzumab plus anthracycline

 FE decline >10% or 5% if EF <50% by ECHO or MUGA 468

  • Lisinopril (10 mg)

  • Carvedilol extended release (10 mg)

  • Lisinopril (10 mg)

  • Carvedilol extended release (10 mg)

  • 1–2 years

  • 1–2 years

  • 1–2 years

  • 1–2 years

  • No difference from placebo

  • No difference from placebo

  • HR 0.53 P = 0.015

  • HR 0.49 P = 0.009

  • No benefit

  • No benefit

  • Benefit

  • Benefit
Gulati (PRADA) 2016 Anthracycline +/−Trastuzumab Change in EF by CMR 130

  • Candesartan (8–32 mg)

  • Metoprolol (50–100 mg)

 10–61 weeks

  • Modest decline in EF with candesartan vs. placebo (P = 0.025)

  • No change in EF with metoprolol vs. placebo

  • Mild benefit

  • No benefit

  • Heck

  • (PRADA EXTENDED)

  • 2021

  • Anthracycline +/− trastuzumab

  • Change in EF from baseline by

  • CMR

 130

  • Candesartan (8–32 mg)

  • Metoprolol (50–100 mg)

 2 years

  • EF decline 1.7% with candesartan vs. 1.8% with no candesartan

  • EF decline 1.6% with metoprolol vs. 1.9% with no metoprolol

  • No benefit

  • Small reduction in LVED and preserved GLS

  • No benefit
Pituskin (MANTICORE-101 BREAST) 2017 Trastuzumab (25% with anthracycline)

  • LV remodelling: LVEDVi

  • CMR

 94

  • Perindopril (2–8 mg)

  • Bisoprolol (2.5–10 mg)

 52 weeks

  • Attenuated EF decline but LV remodelling not prevented

  • Attenuated EF decline and LV remodelling prevented

  • Possible benefit

  • Possible benefit

EF: ejection fraction; LVED: left ventricular end diastolic volume; LVEDi: left ventricular end diastolic volume index; ECHO: echocardiography; CMR: cardiac magnetic resonance; HR: hazard ratio.