Livi L, Barletta G, Martella F, et al. - Good tolerability of cardioprotective pharmacological strategies was evident in patients receiving an anthracycline-based chemotherapy for breast cancer, and such strategies appeared to protect against cancer therapy–related left ventricular ejection fraction (LVEF) decline and heart remodeling.

• This 4-arm, randomized, phase 3, double-blind, placebo-controlled, national multicentric study was a prespecified interim analysis.

• Of 262 patients with breast cancer, 174 were analyzed.

• Cardioprotective therapy (bisoprolol, ramipril, or both drugs vs placebo) was given for 1 year from chemotherapy start or until the end of trastuzumab therapy in case of ERBB2-positive patients.

• Worsening of 3-dimensional-LVEF by 4.4% was evident at 12 months in the placebo arm and by 3.0%, 1.9%, 1.3% in the ramipril, bisoprolol, ramipril plus bisoprolol arms, respectively.

• In the placebo arm and in the ramipril and bisoprolol arms, global longitudinal strain worsened by 6.0%, 1.5% and 0.6%, respectively, whereas it was not altered (0.1% improvement) in the ramipril plus bisoprolol arm.

• Findings indicate that pharmacological cardioprevention may be warranted during cardiotoxic therapy for breast cancer.