PROACT

• Adult patients with histopathologically confirmed breast carcinoma who have received surgery for their breast cancer (including patients with HER2+ breast cancer);

• planned to receive a 6 cycle adjuvant chemotherapy regimen containing > 300mg / m2 of epirubicin;

• Written informed consent 

• 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. Aliskerin, 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

• Herceptin planned treatment within four weeks following anthracycline chemotherapy

• For patients of childbearing potential: refusal to use adequate contraception throughout the trial;

• any other cancer diagnosis;

• judgment 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. 

Research Nurse: Nicola Slawson (Ext No. 53062) Nicola.Slawson@nhs.net

Administrator: Tamaryn Louw