Researchers at the University of Texas M. D. Anderson
Cancer Center have found that cancer patients who develop heart failure as a
result of chemotherapy can be treated effectively, with the condition potentially
reversed, when standard medication for heart failure is administered. The findings
were presented at the sixth annual scientific meeting of the Heart Failure Society
of America by Dr. Jean-Bernard Durand, assistant professor in the department
of cardiology and director of the cardiomyopathy service at M. D. Anderson.
The retrospective studies showed that patients treated with
angiotensin converting enzyme (ACE)-inhibitors and the beta-blocking agent
carvedilol (Coreg) improved significantly in two measures of heart failure:
ejection fraction and New York Heart Association (NYHA) functional class.
Previously, many cancer patients endured the invasive insertion of cardiac
devices or full heart transplants in an effort to treat heart failure resulting
"Until now, heart failure was thought to be irreversible
in chemotherapy patients, with many cardiologists advising patients who develop
the condition to reduce their chemotherapy regimens," said Dr. Durand, lead
investigator of the study. "These data suggest that patients can continue
their chemotherapy regimens, yet effectively reduce their risk of worsening
heart failure and the eventual need for heart transplantation."
According to Dr. Durand, chemotherapeutic agents,
particularly at high doses, may cause direct injury to the heart, with 30% to
50% of chemotherapy patients developing heart failure.
Dr. Durand presented two retrospective studies evaluating the
treatment of heart failure in chemotherapy patients. In one study, investigators
reviewed the medical records of 15 cancer inpatients with class IV heart failure
evaluated at M. D. Anderson’s cardiomyopathy clinic. Cancer diagnosis,
ejection fraction, recorded symptoms, and hemodynamic data were examined before
and after the use of intravenous inotropic agents, beta-blocking agents, ACE
inhibitors, and diuretics. Of the 15 patients, 14 achieved significant recovery
of cardiac function and improvement in NYHA functional class following
treatment, and 13 were successfully discharged on a regimen of ACE inhibitors in
combination with carvedilol.
In a second retrospective study, Dr. Durand and investigators
reviewed the medical records of 16 cancer outpatients with mild to severe heart
failure, also initially evaluated at M. D. Anderson’s cardiomyopathy clinic.
All 16 patients received standard combination therapy for heart failure, which
included ACE inhibitors, diuretics, and carvedilol, unless they were unable to
tolerate therapy. Ten patients had a baseline left-ventricular ejection fraction
(LVEF) less than 40% and six patients had an LVEF greater than 40%.
Results showed that carvedilol treatment alone yielded a mean
increase in ejection fraction units in both groups of patients22% and 15%,
respectively. Carvedilol in combination with an ACE inhibitor yielded a 25%
increase in ejection fraction in patients with an LVEF of less than 40% and a
16% increase in patients with an LVEF of more than 40%.