New data suggests chemotherapy patients benefit from heart failure treatment

More than one-third of patients undergoing chemotherapy at risk for heart failure

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 treatment can be effectively treated, with the condition potentially reversed, when standard medicated therapy for heart failure is utilized.

The findings were presented today at the Sixth Annual Scientific Meeting of the Heart Failure Society of America in Boca Raton by Dr. Jean-Bernard Durand, assistant professor in the Department of Cardiology and director of Cardiomyopathy Service at M. D. Anderson.

The retrospective studies showed that patients treated with ACE-inhibitors and the beta-blocking agent, carvedilol, had significant improvements 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 from chemotherapy treatment.

The research has not been traditionally studied in cancer patients, and is believed to be the first to evaluate the treatment of heart failure using standard medication therapy in patients undergoing chemotherapy.

“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,” say Dr. Durand, lead investigator for the study. “This data suggests that patients can continue their chemotherapy regimens, yet effectively reduce their risk of worsening heart failure and the eventual need for heart transplantation.”

Heart failure develops when the heart is weakened and unable to pump blood efficiently through the body. It commonly results from damage to the heart after a heart attack, high blood pressure or diabetes. According to Dr. Durand, however, chemotherapeutic agents — particularly at high doses — may also cause direct injury to the heart, which can be potentially fatal or result in the need for heart transplantation and/or mechanical assistance heart devices. Dr. Durand says that 30 percent to 50 percent of chemotherapy patients will develop heart failure.

Dr. Durand presented today two retrospective studies evaluating the treatment of heart failure in chemotherapy patients. In one retrospective study, investigators reviewed the medical records of fifteen cancer inpatients with class IV heart failure evaluated in 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. Fourteen of the 15 patients achieved significant recovery of cardiac function and improvement in NYHA functional class following treatment and 13 patients 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 from 16 cancer outpatients with mild to severe heart failure, diagnosed at initial evaluation in M. D. Anderson’s cardiomyopathy clinic. All 16 patients received standard combination therapy for heart failure, which included ACE inhibitors, diuretics and the beta-blocking agent carvedilol, unless unable to tolerate therapy. Ten patients had baseline left ventricular ejection fraction (LVEF) of less than 40 percent and six patients had LVEF of greater than 40 percent.

Results showed that carvedilol treatment alone yielded a mean increase in ejection fraction units in both groups of patients, 22 percent and 15 percent, respectively. Carvedilol in combination with an ACE inhibitor yielded a 25 percent increase in ejection fraction in patients with LVEF less than 40 percent and a 16 percent increase in patients with LVEF more than 40 percent.

“The data demonstrate that chemotherapy-induced heart failure may be reversible with standard medicated therapy for the condition,” says Dr. Durand. “The implications of this research could lead to better chemotherapy regimens for patients without concern for developing a potentially fatal condition as a result of their cancer treatment.”

M. D. Anderson researchers have proposed conducting a broader-scaled study in the near future to further analyze these observations.