New Data Suggest Chemotherapy Patients Benefit From Heart Failure Treatment

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 withangiotensin converting enzyme (ACE)-inhibitors and the beta-blocking agentcarvedilol (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 cardiacdevices or full heart transplants in an effort to treat heart failure resultingfrom chemotherapy.

"Until now, heart failure was thought to be irreversiblein chemotherapy patients, with many cardiologists advising patients who developthe condition to reduce their chemotherapy regimens," said Dr. Durand, leadinvestigator of the study. "These data suggest that patients can continuetheir chemotherapy regimens, yet effectively reduce their risk of worseningheart 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% to50% of chemotherapy patients developing heart failure.

Two Studies

Dr. Durand presented two retrospective studies evaluating thetreatment of heart failure in chemotherapy patients. In one study, investigatorsreviewed the medical records of 15 cancer inpatients with class IV heart failureevaluated at M. D. Anderson’s cardiomyopathy clinic. Cancer diagnosis,ejection fraction, recorded symptoms, and hemodynamic data were examined beforeand after the use of intravenous inotropic agents, beta-blocking agents, ACEinhibitors, and diuretics. Of the 15 patients, 14 achieved significant recoveryof cardiac function and improvement in NYHA functional class followingtreatment, and 13 were successfully discharged on a regimen of ACE inhibitors incombination with carvedilol.

In a second retrospective study, Dr. Durand and investigatorsreviewed the medical records of 16 cancer outpatients with mild to severe heartfailure, also initially evaluated at M. D. Anderson’s cardiomyopathy clinic.All 16 patients received standard combination therapy for heart failure, whichincluded ACE inhibitors, diuretics, and carvedilol, unless they were unable totolerate therapy. Ten patients had a baseline left-ventricular ejection fraction(LVEF) less than 40% and six patients had an LVEF greater than 40%.

Reversible Condition

Results showed that carvedilol treatment alone yielded a meanincrease in ejection fraction units in both groups of patients—22% 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 a16% increase in patients with an LVEF of more than 40%.

"The data demonstrate that chemotherapy-induced heartfailure may be reversible with standard medicated therapy for thecondition," said Dr. Durand. "The implications of this research couldlead to better chemotherapy regimens for patients, without concern fordeveloping a potentially fatal condition as a result of their cancertreatment."