Clinical Drug Experience Knowledgebase

Criteria

Inclusion Criteria:

Written informed consent.
Adult patients with histopathologically* confirmed breast carcinoma who have received surgery for their breast cancer; planned to receive 6 cycles of EC 90 (total planned dose 540mg/m2 epirubicin) or FEC 75 (total planned dose 450mg/m2 epirubicin) adjuvant chemotherapy regimen. Patients with HER2+ breast cancer are eligible for inclusion.

OR

Adult patients with histopathologically confirmed non-Hodgkin lymphoma (NHL), planned to receive 6 cycles of R-CHOP or CHOP (total planned dose 300mg/m2 doxorubicin) chemotherapy**

Patients with HER2+ breast cancer are eligible for inclusion. ** Patients who will receive an alternative anti-CD20 monoclonal antibody are eligible (for example O-CHOP), as long as the total planned doxorubicin dose is ≥300mg/m2 over 6 cycles

Exclusion Criteria:

Positive baseline cardiac troponin T (≥14ng/L);
known contraindication to ACE inhibitor e.g. renal artery stenosis, severe aortic stenosis;
are taking, or have a previous intolerance to ACEI (e.g. angioedema);
patient already taking other agents acting on the renin-angiotensin-aldosterone system e.g. Aliskiren, angiotensin receptor blockers (ARBs), Entresto (sacubitril/valsartan), spironolactone, eplerenone;
LVEF <50%*;
estimated GFR < 30 mL/min/1.73m2 at baseline;
hyperkalaemia defined as serum potassium ≥5.5mmol/L;
symptomatic hypotension, or Systolic Blood Pressure <100mmHg;
poorly-controlled hypertension (Blood Pressure >160/100mmHg**, or ambulatory BP of 150/95mmHg);
previous myocardial infarction;
known metastatic breast cancer;
previous exposure to anthracycline chemotherapy;
are pregnant or breastfeeding;
previous Herceptin treatment or planned Herceptin treatment within four weeks following anthracycline chemotherapy;
for patients of childbearing potential: refusal to use adequate contraception throughout the trial;***
any other invasive cancer diagnosed and treated in the past 5 years;
symptomatic or severe asymptomatic radiation-induced cardiac disease;
judgement by the investigator that the patient has a prognosis of < 1 year or are unlikely to complete 6 cycles of chemotherapy;
judgement by the investigator that the patient is high risk for tumour lysis syndrome (applicable only to NHL patients);

judgement by the Investigator that the patient should not participate in the study, for example, if the patient is unlikely to comply with study procedures, restrictions, and requirements.

*<50% as defined by Simpson's biplane method; if absolute measurements are not possible, then a visually normal assessment of LVEF is acceptable for inclusion.

**White coat hypertension is more common, and should be ruled out by an ambulatory blood pressure monitor

***Female patients between the ages of 18 and 50 will receive a pregnancy test at baseline. Adequate methods of contraception are those that can achieve a failure rate of less than

1% per year when used consistently and correctly, such methods include:

combined (estrogen and progestogen containing) hormonal contraception associated with inhibition of ovulation

oral
intravaginal
transdermal

progestogen-only hormonal contraception associated with inhibition of ovulation

oral
injectable
implantable
intrauterine device (IUD)
intrauterine hormone-releasing system (IUS)
bilateral tubal occlusion
vasectomy/vasectomised partner
true sexual abstinence