Can flax "milk" prevent chemotherapy mediated cardiotoxicity in women with breast cancer?

Cardio-oncology focuses on the prevention, diagnosis, and management of cancer patients who are at risk of developing cardiovascular complications as a result of their anti-cancer treatment. Amongst the various pharmacological therapies which may prevent anthracycline mediated cardiotoxicity in women with breast cancer, including renin-angiotensin system (RAS) antagonists, beta blockers, and statins, there has been an increased interest on the role of nutraceuticals in this setting. Although we recently demonstrated the cardioprotective role of dietary flaxseed (FLX) in the prevention of adverse cardiovascular remodeling in a chronic in vivo female murine model of anthracycline mediated cardiotoxicity, little is known on the effects of this dietary agent in the clinical setting.

The aim of the "Can flax "milk" prevent chemotherapy mediated cardiotoxicity in women with breast cancer (CANFLAX-BC)" study was to investigate whether consumption of FLX "milk" can prevent cardiac dysfunction in women with breast cancer treated with anthracyclines.

In this double-blinded, single centre, prospective randomized controlled clinical trial, women with breast cancer were randomized to oral consumption of either placebo oat fiber "milk" or FLX "milk" [each containing 30 grams of oat or flaxseed, respectively] for a total of 4 months while receiving anthracycline-based chemotherapy. Serial echocardiography was performed at baseline, 4-month, and 6-month follow-up.

Between September 2021 and December 2023, a total of 21 women with early-stage breast cancer (EBC) (mean age 48±10 years, BMI 28±5 kg/m2) were enrolled in the CANFLAX-BC study. During the 4-month intake period, a total of 8 women received oat fibre "milk" and 13 women received FLX "milk", with a comparable adherence rate of approximately 70% for both groups. At baseline, 4-month, and 6-month follow-up, the LVEF was 68±4%, 69±3%, 66±4% for the oat fibre "milk" group, and 67±5%, 68±4%, 66±5% for the FLX "milk" group (no significant difference; Table 1, Figure 1A). Although the mean global longitudinal strain (GLS) was comparable between both groups at baseline, the GLS was significantly lower at -13.8±0.3% (4 months) and -15.1±0.3% (6 months) for the oat fibre "milk" group, as compared to a preserved GLS of -18.4±0.3% (4 months) and -18.5±0.2% (6 months) for the FLX "milk group (*p<0.05; Table 1, Figure 1B).

In women receiving anthracycline based chemotherapy for breast cancer, FLX "milk" consumption prevents early cardiotoxicity, as reflected by the preservation of GLS parameters.

Table 1

Figure 1