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| |  HFSA: Carvedilol Alone or in Combination With Standard Therapy Reverses Chemotherapy-Induced Congestive Heart Failure By Candace Hoffmann Special to DG News BOCA RATON, FL -- September 26, 2002 -- Carvedilol, alone or in combination with standard heart failure therapy, appears to reverse chemotherapy-induced congestive heart failure. Dr. Elizabeth Newsome and colleagues from the M.D. Anderson Cancer Center, in Houston, Texas, United States, reported the finding here September 24th at the 6th Annual Scientific Meeting of the Heart Failure Society of America. One of the serious side effects of chemotherapeutic agents such as adriamycin is congestive heart failure (CHF), which is seen in 15 percent of the patients on the drug. "No previous clinical trials have ever been performed to evaluate the effectiveness of ACE inhibition and non-selective beta blockade in the cancer patient with CHF," the researchers say. This is probably due to cancer patients historically being excluded from heart trials and heart patients excluded from cancer trials. They undertook a chart review of 16 patients who were diagnosed with heart failure that was not due to any cause other than chemotherapy. Patients with underlying ischemia were excluded from the trial. The patients, who all had ejection fractions < 40 percent after chemotherapy, were treated with standard therapy unless they could not tolerate it. They received follow-up echocardiograms and their New York Heart Association (NYHA) class was determined once on stable therapy. The patients were then divided into two groups based on their baseline left ventricular ejection fractions (LVEF). Group 1 comprised ten patients with a baseline LVEF < 40 percent. Of these, three received carvedilol alone and seven received carvedilol plus angiotensin converting enzyme inhibitor (ACE-I). Group 2 comprised six patients with baseline LVEF > 40 percent. Two of these received carvedilol alone and four received carvedilol plus ACE-I. Overall there were a mean increase in EF of 22 percent in Group 1 and 15 percent in Group 2. For those on the beta-blocker alone, the mean increase was 18 percent and 15 percent for group 1 and group 2, respectively. For the combination therapy, there was a 25 and 16 percent increase for group 1 and group 2, respectively. "Although both therapies improved LV function, the mean increase in LVEF in patients who received combination therapy was 8 percentage points greater," the researchers say. "This represents a novel approach to chemotherapy-induced heart failure and warrants further investigation to look at the potential cardioprotective benefits of using beta-blocker and ACE-inhibitor therapy for those patients at risk of developing heart failure."
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