Using medicines for the heart to improve outcomes in women with breast cancer

A key pillar of the George Institute’s mission is to find better treatments for the world’s biggest health problems. With cancer being the second-leading cause of death worldwide, the Institute’s researchers are now using their expertise to help improve outcomes for women with a particular type of breast cancer.

According to the National Breast Cancer Foundation, breast cancer is the most commonly diagnosed cancer in Australia, with approximately 55 new cases diagnosed each day, or over 20,000 a year.

Around 10–15 percent of these patients will have the HER2-positive type, characterised by high levels of the HER2 (human epidermal growth factor receptor 2) protein on the surface of the cancer cells.

Monoclonal antibodies targeting this receptor protein are the mainstay of HER2-positive breast cancer therapy, but in around one in ten patients they can cause damage to the heart. This can lead to patients having to interrupt or stop their cancer treatment, which impacts their chances of survival.

George Institute researchers, together with a team from The Garvan Institute of Medical research recently completed a review of studies that have tried using heart failure treatments to prevent heart damage associated with this type of cancer therapy.

The team identified five clinical trials including over 900 patients that were completed in both early and metastatic disease. They found no significant difference in the number of people who developed heart complications when they were treated with preventative heart medication, compared to those on placebo. But Dr Clare Arnott, Co-Director of the George Institute’s Better Treatments Program said that certain medications did appear to reduce the risk of cancer treatment being interrupted.

“We need more evidence to know whether we should be prescribing these medications to patients undergoing HER2 positive chemotherapy to improve their heart outcomes,” she said.

The team has now received funding to set up a pilot study to help fill the evidence gap.

“The study aims to prevent cardiotoxicity from treatment with the drug herceptin in women with breast cancer - there are currently no proven therapies to prevent the adverse effects of this drug on heart function,” said Dr Arnott.

“We hope this research will lead to more such trials, so that doctors and patients have the information they need to decide whether to add preventative heart treatment to their care.”

The theme of this year’s World Cancer Day, “Close the Care Gap”, and according to Prof Anil d’Cruz, President of the Union for International Cancer Control, Director of Oncology at Apollo Hospitals, India,

“By 2030, it is estimated that 75% of all premature deaths due to cancer will occur in low- and middle-income countries. Importantly, this care gap is not only between high- and low-resource settings. Disparities exist within most countries among different populations due to discrimination or assumptions that encompass age, cultural contexts, gender norms, sexual orientation, ethnicity, income, education levels and lifestyle issues. These factors potentially reduce a person’s chance of surviving cancer – and they can and must be addressed.”