Can flaxseed “milk” prevent anthracycline mediated cardiotoxicity in women with breast cancer (CANFLAX-BC)?

Background:  Cardio-Oncology focuses on the prevention, diagnosis, and management of individuals with cancer who are at risk of developing cardiovascular complications as a result of their anti-cancer treatment.   The aim of the “Can flaxseed “milk” prevent chemotherapy mediated cardiotoxicity in women with breast cancer (CANFLAX-BC) study” was to investigate whether consumption of flaxseed (FLX) “milk” can prevent cardiac dysfunction in women with breast cancer treated with anthracyclines.  Methods:  In this small pilot 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” for a total of 4 months while receiving anthracycline-based chemotherapy.  Serial echocardiography and cardiac biomarkers were measured at baseline, 4-months, and 6-months follow-up.  Results:  Between 2021 and 2023, a total of 21 women with early-stage breast cancer (mean age 48 ± 10 years, BMI 28 ± 5 kg/ m² ), treated with an anthracycline based chemotherapy regimen, 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” while receiving anthracyclines, with a comparable adherence rate of 70% for both groups.  At baseline, 4-months, and 6-months follow-up, the LVEF was 68 ± 4%, 69 ± 3% and 66 ± 4%, respectively, for the oat fibre “milk” group and 67 ± 5%, 68 ± 4%, and 66 ± 5%, respectively, for the FLX “milk” group (p=NS).  Although the mean global longitudinal strain (GLS) was comparable between both groups at baseline, the GLS was 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 GLS of -18.4 ± 0.3% (4 months) and -18.5 ± 0.2% (6 months) for the FLX milk group (p<0.05).  Conclusion :  In women receiving an anthracycline based chemotherapy regimen for breast cancer, this small pilot study suggests the FLX “milk” consumption may prevent early cardiotoxicity as reflected by preservation of GLS parameters.