A frequently prescribed heart failure medication has been found to reduce the risk of heart damage, known as cardiotoxicity, in cancer patients who are considered high-risk and undergoing chemotherapy with anthracyclines. This finding was revealed in recent research presented at the American Heart Association’s Scientific Sessions 2024, which took place from November 16-18, 2024, in Chicago. The event serves as a key global platform for sharing the latest scientific discoveries, research, and updates in cardiovascular science.
A frequently prescribed heart failure medication has been found to reduce the risk of heart damage, known as cardiotoxicity, in cancer patients who are considered high-risk and undergoing chemotherapy with anthracyclines. This finding was revealed in recent research presented at the American Heart Association’s Scientific Sessions 2024, which took place from November 16-18, 2024, in Chicago. The event serves as a key global platform for sharing the latest scientific discoveries, research, and updates in cardiovascular science.
Study lead author Marcely Bonatto, M.D., a cardiologist and heart failure specialist at the Heart Institute, University of São Paulo in Curitiba, Brazil, stated, “We have discovered a promising new approach to safeguarding the heart during cancer treatment. This could significantly influence patient care and future investigations in both heart disease and cancer. Our method allows for early detection of individuals at high risk for heart dysfunction, enabling timely actions to preserve heart function.”
Heart failure occurs when the heart is unable to pump blood effectively, failing to deliver adequate blood and nutrients throughout the body. Anthracyclines are chemotherapy agents commonly used to treat various cancers such as breast cancer, leukemia, lymphoma, and sarcoma. A notable side effect of these drugs is cardiomyopathy—a disease affecting the heart muscle that impairs its ability to pump blood. This condition is categorized as cardiotoxicity, which denotes heart injury caused by chemotherapy.
The SARAH clinical trial focused on the effects of sacubitril-valsartan, a heart-failure medication classified as an angiotensin receptor neprilysin inhibitor (ARNI), in preventing additional heart damage among 114 patients receiving anthracycline-based chemotherapy for cancers like breast cancer, lymphoma, sarcoma, and leukemia.
The study’s findings included:
- When compared to a placebo, sacubitril/valsartan resulted in a 77% reduction in the relative risk of further heart damage among patients already exhibiting signs of damage. The decrease in cardiotoxicity was monitored from the start of treatment to the end of the 24-week intervention.
- Participants initiated treatment with 24/26 mg of sacubitril/valsartan, taken twice daily, and the dosage was adjusted every two weeks until reaching the target dose of 97/103 mg twice daily, or the maximum dose tolerated by the patients. The medication was generally well accepted by participants, according to researchers.
- Those who took sacubitril/valsartan exhibited a significantly lower likelihood of developing additional heart damage by the conclusion of the 24-week period compared to placebo recipients. Furthermore, individuals in the treatment group enhanced their global longitudinal strain (GLS), a measure of heart function, by an average of 2.55%, whereas participants receiving a placebo saw an average decline of 6.65% in GLS.
Bonatto emphasized, “Our results underscore the need to identify high-risk patients who are likely to benefit from heart protection, thereby reducing unnecessary side effects and healthcare costs for those at lower risk. Identifying who will gain from this strategy remains a considerable challenge.”
The study acknowledged several limitations, including that all participants were already at high risk for heart damage and specifically receiving anthracyclines for chemotherapy—113 received doxorubicin and one received daunorubicin—indicating that results may not apply to lower-risk individuals or those treated with other chemotherapy agents. The study could not track heart damage post the six-month follow-up and did not explore other variables like survival rate or quality of life. Conducted at a single hospital in Brazil, the findings may have limited applicability to patients treated elsewhere. Further research with a more diverse patient population is necessary, as study participants were predominantly white and female.
Background and additional study details include:
- The SARAH trial involved 114 adults diagnosed with cancer who were undergoing chemotherapy at Erasto Gaertner, a cancer hospital in Curitiba, Brazil. Of these patients, 80.7% were treated for breast cancer, 16.7% for leukemia, 1.7% for sarcoma, and 0.9% for leukemia.
- The average age of participants was 52, with 90% identifying as women and 10% as men. White adults made up 92% of participants, while 7% identified as Black or mixed-race (Pardo), and 1% as Asian adults.
- All participants were deemed high-risk due to pre-existing heart damage, indicated by elevated troponin levels in the blood—this protein is released by the heart when it suffers damage.
- Participants underwent regular clinical assessments, including blood tests and specialized heart evaluations via echocardiography and cardiac MRI, over a six-month period to monitor heart damage and functionality changes.
- The study took place from March 2022 to August 2024.
