Many breast cancer survivors whose treatment caused problems with their heart function can safely stop medication after their heart recovers, finds a new study led by researchers at University College London.
The trial, which was funded by the British Heart Foundation, involved 90 women who had recovered from heart problems caused by a specific type of breast cancer treatment. Most were in their 40s and 50s and would previously have been advised to stay on heart medication for life, due to fears their heart function would decline once the drugs were stopped.
Researchers found that 98% of the group who stopped taking their heart medication had no change in their heart function after one year, with only one woman experiencing a decline in her heart’s pumping ability.
Women who came off their medication also reported a slightly better quality of life at 12 months than those who continued, based on their scores on questionnaires designed to measure quality of life in people with heart failure. The study is published in the European Heart Journal and was presented at the European Society of Cardiology Congress in Munich.
The women in the trial will continue to be followed up over the next five years to monitor their heart health. But the researchers suggest their findings can start important conversations between survivors and their doctors about whether they need to continue treatment long-term.
Professor Charlotte Manisty (UCL Institute of Cardiovascular Science), who is also a consultant cardiologist at Barts Heart Centre and UCLH, said: “Modern breast cancer treatment is a remarkable success story. But the damaging effects of these drugs on the heart leave survivors and their doctors with difficult questions about ongoing treatment to maintain their heart health.
“Our study provides the first evidence that heart failure therapies can be safely stopped in survivors whose hearts have recovered, with the support of ongoing close monitoring. We hope these findings will be encouraging for survivors and their doctors, giving hope for a future free from treatment.”
These patients are usually offered targeted biological treatments such as Trastuzumab (better known as Herceptin), which attach to HER2 receptors to help block the growth and spread of cancer. But in around 10% of patients, this treatment causes problems with heart function, leaving them in need of treatment with multiple medications – such as beta-blockers and ACE inhibitors – to help recovery. Survivors are currently advised to stay on these drugs for life, even after their cancer treatment ends and their heart recovers.
The trial involved 90 breast cancer survivors at four hospitals in the UK who started taking heart failure medication after a diagnosis of HER2-targeted therapy-related cardiac dysfunction, but whose hearts later recovered following treatment. All study volunteers were women, with an average age of 50.
Everyone in the study was randomly assigned to either gradually withdraw from their heart failure medication (46 women) or to continue taking it (44 women). They were followed closely for one year with blood tests, quality-of-life questionnaires and cardiac MRI scans to check whether their heart function had worsened.
One woman in the group that stopped their medication experienced a decline in her left ventricular ejection fraction (a measure of the heart’s pumping ability). She didn’t report any symptoms, but the decrease was picked up on an MRI scan at 12 months. Her heart function improved when she started taking their heart failure medication again.
None of the group that continued to take their heart failure treatment saw a decline in their heart function.
Overall, left ventricular ejection fraction remained stable in both groups (minus one per cent in the withdrawal group and minus 0.2% in the continuation group) with no significant differences between the two groups after one year (withdrawal group 55.2 per cent compared to 55.6% in continuation group).
None of the women in the trial reported any heart failure symptoms, required hospital treatment or experienced any other heart problems during the trial.
Dr Sonya Babu-Narayan, clinical director at the British Heart Foundation and consultant cardiologist, said: “These findings will be hugely encouraging for the thousands of breast cancer survivors whose heart health has been affected by lifesaving cancer treatment.
“The study results give hope that many women will be able to safely stop medicines once their heart has recovered. The importance of ongoing monitoring is highlighted by the one study participant whose heart scan showed her heart function deteriorated but then bounced back when her heart treatment was restarted. More research is needed and the women will be followed up for longer, but in the meantime the good news for this group of breast cancer survivors is lifelong medications after heart complications need not be the default.”
Source: University College London
