No cardioprotective effect of ACE inhibitors in patients with cancer

In the phase 3 PROACT trial, the ACE inhibitor enalapril did not show benefit in patients with cancer against anthracycline-related cardiotoxicity. The participants in this trial were undergoing high-dose anthracycline chemotherapy for breast cancer or lymphoma.

The multicentre, open-label, phase 3 PROACT trial (NCT03265574) enrolled 111 participants undergoing treatment for breast cancer (62%) or non-Hodgkin lymphoma (38%) who were randomised to enalapril or placebo [1]. All participants had negative troponin levels at baseline and then received 6 cycles of anthracycline chemotherapy at a mean dose of 328 mg/m² doxorubicin equivalent. Dr David Austin (South Tees Hospitals, UK) and colleagues assessed participants’ troponin levels during their chemotherapy treatment and at 1 month following their last anthracycline dose.

At the end of the study period, no significant between-group difference was found in the proportion of participants who had experienced a troponin T release (the primary study endpoint): this occurred in 77.8% of the enalapril group and 83.3% of the standard-of-care group (adjusted odds ratio 0.65; P=0.405).

“We did not see evidence that we could reduce this biomarker of cardiotoxicity during chemotherapy,” said Dr Austin. “The conclusion from PROACT is that we would not support putting enalapril into a standard care preventative pathway in these patients.”

1. 
   
   1. Austin D, et al. PROACT: Can we prevent chemotherapy-related heart damage in patients with breast cancer and lymphoma? LB4, Session 411, ACC 2024 Scientific Session, 6–8 April, Atlanta, USA.

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Posted on 16 May 202417 May 2024