Biomarker-Guided Cardioprotection in Patients with Lymphoma or Breast Cancer Treated with Anthracyclines

Inclusion Criteria

• Provision of written informed consent and Health Insurance Portability and Accountability Act (HIPAA) authorization
• Stated willingness to comply with all study procedures and availability for the duration of the study
• Male or female, >= 18 years of age
• Diagnosed with breast cancer or lymphoma (any subtype), planned to receive an anthracycline based chemotherapy regimen. Patients may be enrolled up to their first dose of anthracycline even if they have already received other chemotherapeutic or targeted agents as part of neoadjuvant or adjuvant systemic therapy. * Note: The treating oncologist will determine whether patient will receive anthracyclines

Exclusion Criteria

• Diagnosed with stage IV breast cancer
• Uncontrolled blood pressure defined by systolic blood pressure (SBP) > 180 mmHg on two or more occasions and taking three or more antihypertensives within 1 month prior to start of anthracyclines
• Baseline systolic blood pressure < 90 mmHg (if multiple blood pressures are available in the medical record within 1 month prior to screening, the average SBP will be considered)
• Women must not be pregnant or breast-feeding due to the potential harm to an unborn fetus and possible risk for adverse events in nursing infants with some anti-hypertensives, including angiotensin receptor blockers. All females of childbearing potential must have a blood test or urine study within 10 days prior to registration to rule out pregnancy. All females of childbearing potential must be strongly advised to use accepted and effective methods of contraception or to abstain from sexual intercourse for the duration of their participation in the study. A female of childbearing potential is defined as any woman, regardless of sexual orientation or whether they have undergone tubal ligation, who meets the following criteria: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy; or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months)
• Patient with prior or concurrent malignancy whose natural history of treatment, in the opinion of the investigator, has the potential to interfere with the safety or efficacy assessment of the investigational regimen
• Severe hepatic impairment, defined as serum bilirubin > upper limit of normal (ULN), or aspartate aminotransferase (AST) or alanine aminotransferase (ALT) > 5.0 ULN within 28 days of enrollment
• Patient must not have end-stage renal failure on dialysis, history of repeated hyperkalemia with a potassium > 5.5 mEq/l, or have a history of kidney transplant, or an estimated glomerular filtration rate (eGFR) < 30 ml/min/1.73 m^2
• Patients in cardiogenic shock or decompensated heart failure requiring the use of intravenous (IV) inotropic therapy
• Note: Patient with a noted severe allergic reaction or absolute contraindication to one medication or medication class is not necessarily excluded from this trial; treatment plans for patients with any allergy or contraindication to a proposed medication will be made in consultation with the study principal investigator (PI). Another class of agents will be used if there is a severe or absolute contraindication to one of the medicines in one class. Moreover, the patient treated with pre-existing medications that may interact with proposed blood pressure (BP) medications is not necessarily excluded; the clinical significance of any potential drug interactions can also be addressed with the study PI