The Cardiology Department, Division of Medical Oncology, and Breast Surgery Department at National Cheng Kung University Hospital (NCKU Hospital) have successfully completed the world’s first Phase II clinical trial using a next-generation heart failure drug—Angiotensin Receptor-Neprilysin Inhibitor (ARNI)—to prevent cancer therapy-related cardiac dysfunction (CTRCD). This collaborative research marks a major step forward in achieving safer and more effective integrative care for cancer patients.

Cardiotoxicity remains a major challenge during cancer treatment, often leading to interrupted therapy, diminished quality of life, or even worsened prognosis. The results of this NCKU Hospital study were first presented at the 2024 European Society of Cardiology (ESC) Congress and have now been formally published in the prestigious European Journal of Heart Failure in 2025. With an impact factor of 10.2, the journal is one of the most influential in the field of medicine, underscoring the global academic recognition of the study’s significance.

The NCKU Hospital team implemented a cross-disciplinary care model for cancer patients with cardiovascular comorbidities. Under the leadership of Dr. Liu Ping-Yen, Chair of the Department of Internal Medicine, the team brought together Dr. Tsai Wei-Chuan, Dr. Liu Yen-Wen, Dr. Lee Wen-Huang, and Dr. Hsu Yu-Ling from the Department of Cardiology; Dr. Chung Wei-Bang, Dr. Lee Chun-Hui, Dr. Tsai Jui-Hung, and Dr. Yang Shun-Ju from the Division of Medical Oncology; and Dr. Lee Kuo-Ting (Director), Dr. Hsu Hui-Ping, and Dr. Lo Chu-Chun from the Breast Surgery Department. Together, they created a comprehensive clinical model that spans breast cancer diagnosis, chemotherapy, cardiac protection, and long-term follow-up care.

Four years ago, at the suggestion of Dr. Liu Ping-Yen, the hospital established a specialized "Cardio-Oncology Clinic" within the cancer center’s inpatient ward. Dr. Liu Yen-Wen became the first attending physician. Before beginning chemotherapy or targeted therapy, cancer patients receive cardiac ultrasounds and function assessments from cardiologists. Throughout treatment, patients are closely monitored for changes in cardiac function, allowing for timely interventions and individualized, one-stop integrative care—especially valuable in the management of breast and pancreatic cancer patients.

This research also received strong support from the National Health Research Institutes under the "Early Phase Clinical Trial Enhancement Program," highlighting the power of academic medical centers to integrate multi-disciplinary resources.

The clinical trial demonstrated significant outcomes: ARNI effectively prevents deterioration in cardiac function. The study enrolled 100 women (98% female) with a mean age of 50.4 who were receiving adjuvant chemotherapy for breast cancer for the first time. Participants in the experimental group began low-dose ARNI three days before chemotherapy and were compared with a control group receiving standard care over a one-year period. Results showed that none of the patients in the ARNI group experienced cardiac function decline, whereas 26.3% in the control group developed CTRCD (p = 0.006). The findings confirm ARNI’s clear cardioprotective benefits and potential application in future cardio-oncology prevention strategies.

The research also employed Global Longitudinal Strain (GLS) ultrasound technology to track cardiac function in real time. Led by Dr. Tsai Wei-Chuan, the cardiology team used GLS to detect subtle changes earlier than conventional echocardiography, making it a critical tool for identifying all cardiac dysfunction events in the study. This enhances clinical decision-making and underscores the high value of GLS in cancer-related cardiac care.

With both international conference presentation and journal publication, this study marks a new direction in cardio-oncology care. It is the world’s first formally published clinical trial to demonstrate the efficacy of ARNI in preventing cardiotoxicity caused by cancer treatments. The results not only pave a new path for oncology therapies but also set a new standard in the care of patients with concurrent cancer and cardiovascular disease.

The research team plans to launch a larger-scale Phase III clinical trial in the near future, continuing to advance the field of cardio-oncology and offering patients more diversified and forward-looking treatment options.

By integrating specialties and driving innovative research, NCKU Hospital is building a robust safety net for patients with coexisting cancer and heart conditions. As oncology and cardiology continue to evolve, multidisciplinary integration not only enhances the comprehensiveness of treatment but also helps reduce side effects and chronic complications from the outset. This study sets a new benchmark in both domestic and global cardio-oncology care and further demonstrates NCKU Hospital’s leadership in precision medicine, clinical innovation, and team-based collaboration.

Resource: 成醫癌心團隊跨科合作突破　證實新藥有效預防癌症治療心臟毒性