A systematic review and meta-analysis of beta-blockers and renin-angiotensin system inhibitors for preventing left ventricular dysfunction due to anthracyclines or trastuzumab in patients with breast cancer.
Adrenergic beta-Antagonists
/ adverse effects
Angiotensin Receptor Antagonists
/ adverse effects
Angiotensin-Converting Enzyme Inhibitors
/ adverse effects
Anthracyclines
/ adverse effects
Antibiotics, Antineoplastic
/ pharmacology
Antihypertensive Agents
/ therapeutic use
Breast Neoplasms
/ drug therapy
Female
Humans
Male
Renin-Angiotensin System
Stroke Volume
Trastuzumab
/ adverse effects
Ventricular Dysfunction, Left
/ chemically induced
Angiotensin receptor blockers
Angiotensin-converting enzyme inhibitors
Anthracyclines
Beta-blockers
Breast cancer
Cardiotoxicity
Left ventricular ejection fraction
Prevention
Trastuzumab
Journal
European heart journal
ISSN: 1522-9645
Titre abrégé: Eur Heart J
Pays: England
ID NLM: 8006263
Informations de publication
Date de publication:
14 07 2022
14 07 2022
Historique:
received:
26
01
2021
revised:
25
04
2021
accepted:
08
12
2021
pubmed:
25
12
2021
medline:
16
7
2022
entrez:
24
12
2021
Statut:
ppublish
Résumé
Trastuzumab and anthracyclines, often used in the treatment of breast cancer, may impair myocardial function, and reduce left ventricular ejection fraction (LVEF), potentially causing heart failure. Randomized controlled trials (RCTs) have evaluated the effects of beta-blockers (BBs), angiotensin receptor blockers (ARBs), and angiotensin-converting enzyme inhibitors (ACEI) on trastuzumab- and anthracycline-associated cardiotoxicity. We report a meta-analysis of these RCTs in patients with breast cancer. The primary analysis was on the effect of BBs and ACEI/ARBs on LVEF in patients treated with either trastuzumab or anthracyclines. A secondary analysis was done investigating the effect of BBs or ACEI/ARBs on LVEF in trastuzumab and anthracycline treatments. Only RCTs were included using the search term 'ARBs, ACEIs, BBs, anthracyclines, trastuzumab, and breast cancer' in PubMed, Embase, and CENTRAL up to 31 March 2021. A meta-analysis was conducted to estimate the mean difference (MD) in LVEF between intervention and placebo groups at follow-up. A total of nine RCTs (n = 1362) were included in the analysis. All patients were women. BBs and ACEI/ARBs were shown to attenuate the decline in LVEF during trastuzumab and anthracycline treatments [MD: 2.4; 95% confidence interval (CI): 0.3-4.2 and MD: 1.5; 95% CI: -0.6 to 3.7]. Compared with placebo, LVEF was significantly higher in patients assigned to BB or ACEI/ARB on trastuzumab (MD: 2.3; 95% CI: 0.0-4.6) but not on anthracyclines (MD: 1.9; 95% CI: -0.5 to 4.2). Both BB and ACEI/ARB therapies were associated with the preservation of LVEF during trastuzumab and anthracycline-containing regimens as compared with placebo, suggesting both to be beneficial.
Identifiants
pubmed: 34951629
pii: 6482048
doi: 10.1093/eurheartj/ehab843
doi:
Substances chimiques
Adrenergic beta-Antagonists
0
Angiotensin Receptor Antagonists
0
Angiotensin-Converting Enzyme Inhibitors
0
Anthracyclines
0
Antibiotics, Antineoplastic
0
Antihypertensive Agents
0
Trastuzumab
P188ANX8CK
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
2562-2569Commentaires et corrections
Type : CommentIn
Informations de copyright
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.