Impact of Propranolol Strategies on Myocardial Injury After Breast Cancer Surgery

This study aims to evaluate the impact of using propranolol, a non-selective beta-blocker, on preventing myocardial injury after non-cardiac surgery (MINS) in breast cancer patients who also have hypertension or angina. Stress from surgery and anesthesia can increase sympathetic activity and inflammation, which may lead to heart stress. This pragmatic clinical trial will compare patients who are prescribed propranolol as part of their routine care with those who are not. Researchers will analyze blood samples and surgical tissues collected during normal treatment to observe changes in heart health and the tumor microenvironment.

Sex

Female

Minimum age

20 Years

Maximum age

70 Years

Inclusion Criteria:

1. Female patients aged 20 to 70 years.
2. Patients diagnosed with hypertension or angina who require medication.
3. Patients diagnosed with unilateral, resectable primary breast cancer (ICD-10: C50), Stage I-III.
4. ECOG performance status of 0-1.
5. Patients scheduled to receive standard postoperative treatment (including adjuvant radiotherapy
6. Patients who voluntarily decide to participate and sign the written informed consent form

Exclusion Criteria:

1. Patients with distant metastases.
2. Patients with active infectious diseases, autoimmune diseases (including specific rheumatic diseases), coagulation disorders, or cardiovascular diseases other than hypertension or angina pectoris.
3. Patients with clinically significant hepatic, hematologic, or renal dysfunction, defined as any of the following:

   ① ANC \<1,500/mm3
   * Platelets \<100,000/mm3

     * Hb \<9 g/dL

       * AST and ALT \> 2.5 x upper limit of normal (ULN) ⑤ Alkaline phosphatase \> 2.5 x ULN ⑥ Total bilirubin \> 1 x ULN ⑦ Serum creatinine \>1.5 x ULN or estimated creatinine clearance \< 60 mL/min (as calculated using the method standard for the institution)
4. Patients with moderate to severe asthma or chronic obstructive pulmonary disease (COPD).
5. Patients who are pregnant or breastfeeding at the time of enrollment.
6. Patients with a history of malignancy within the past 5 years.
7. Patients for whom data collection is considered difficult at the discretion of the investigator.
8. Patients who are unable to understand or complete study questionnaires.
9. Patients who have received β-blockers within 30 days prior to screening.
10. Patients with systolic blood pressure \< 100 mmHg or heart rate \< 55 beats per minute.

• RESULTO'Logbon J, Tarantola L, Williams NR, Mehta S, Ahmed A, Davies EA. Does propranolol have a role in cancer treatment? A systematic review of the epidemiological and clinical trial literature on beta-blockers. J Cancer Res Clin Oncol. 2025 Jul 12;151(7):212. doi: 10.1007/s00432-025-06262-2. PMID 40652143
• RESULTHiller JG, Cole SW, Crone EM, Byrne DJ, Shackleford DM, Pang JB, Henderson MA, Nightingale SS, Ho KM, Myles PS, Fox S, Riedel B, Sloan EK. Preoperative beta-Blockade with Propranolol Reduces Biomarkers of Metastasis in Breast Cancer: A Phase II Randomized Trial. Clin Cancer Res. 2020 Apr 15;26(8):1803-1811. doi: 10.1158/1078-0432.CCR-19-2641. Epub 2019 Nov 21. PMID 31754048
• RESULTVascular Events In Noncardiac Surgery Patients Cohort Evaluation (VISION) Study Investigators; Devereaux PJ, Chan MT, Alonso-Coello P, Walsh M, Berwanger O, Villar JC, Wang CY, Garutti RI, Jacka MJ, Sigamani A, Srinathan S, Biccard BM, Chow CK, Abraham V, Tiboni M, Pettit S, Szczeklik W, Lurati Buse G, Botto F, Guyatt G, Heels-Ansdell D, Sessler DI, Thorlund K, Garg AX, Mrkobrada M, Thomas S, Rodseth RN, Pearse RM, Thabane L, McQueen MJ, VanHelder T, Bhandari M, Bosch J, Kurz A, Polanczyk C, Malaga G, Nagele P, Le Manach Y, Leuwer M, Yusuf S. Association between postoperative troponin levels and 30-day mortality among patients undergoing noncardiac surgery. JAMA. 2012 Jun 6;307(21):2295-304. doi: 10.1001/jama.2012.5502. PMID 22706835
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