Prevention of anthracycline-induced cardiotoxicity: a systematic review and meta-analysis
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CE-SYSTEMATIC REVIEWS AND META-ANALYSIS
Prevention of anthracycline‑induced cardiotoxicity: a systematic review and meta‑analysis Francesca Caspani1 · Antonino Carmelo Tralongo1 · Leonardo Campiotti2 · Riccardo Asteggiano3 · Luigina Guasti2 · Alessandro Squizzato2 Received: 11 June 2020 / Accepted: 12 September 2020 © Società Italiana di Medicina Interna (SIMI) 2020
Abstract Anthracyclines are extensively used in oncologic patients, in particular for breast cancer and hematological malignancies. Cardiac injury is a potentially dangerous side effect of these drugs. In this systematic review, we analyzed published randomized controlled trials (RCTs) to assess if potential cardioprotective drugs (i.e., renin–angiotensin–aldosterone system [RAAS] blockers and β-blockers) may prevent heart damage by anthracyclines. Studies were identified by electronic search of MEDLINE and EMBASE database until August 2020. The impact of cardioprotective drugs to prevent anthracyclinesinduced cardiac injury was expressed as mean difference (MD) or odds ratio (OR) and 95% confidence intervals (95% CI). Statistical heterogeneity was assessed with the I2 statistic. Twelve RCTs for a total of 1.035 cancer patients treated with anthracyclines were included. RAAS blockers, β-blockers, and aldosterone antagonists showed a statistically significant benefit in preventing left ventricular ejection fraction (LVEF) reduction (MD 3.57, 95% CI 1.04, 6.09) in 11 studies. A nonstatistically significant difference was observed in preventing E/A velocity decrease (MD 0.09, 95% CI 0.00, 0.17; 9 studies), left ventricular end-systolic diameter (LVESD) increase (MD − 0.88, 95% CI, − 2.75,0.99; 6 studies), left ventricular enddiastolic diameter (LVEDD) increase (MD −0.95, 95% CI − 2.67,0.76; 6 studies), and mitral A velocity decrease (MD − 1.42, 95% CI − 3.01,0.17; 4 studies). Heart failure was non-significantly reduced in the cardioprotective arm (OR 0.31, 95% CI 0.06, 1.59; 5 studies). Hypotension was non-significantly increased in the cardioprotective arm (OR 3.91, 95% CI 0.42, 36.46, 3 studies). Cardioprotective drugs reduce anthracycline-induced cardiac damage as assessed by echocardiographic parameters. The clinical relevance of this positive effect is still to be defined. Keywords Cardiotoxicity · Anthracycline · Beta-blockers · ACE inhibitors · RAAS inhibitors
Introduction Anthracyclines (ANT) are among the most effective drugs against cancer, used in a wide spectrum of malignancies, both in adjuvant and metastatic settings, mainly for patients with breast cancer, lymphomas, and pediatric leukemia [1]. However, these drugs have several adverse effects, in particular cardiotoxicity: myocardial damage induced by ANT
* Antonino Carmelo Tralongo [email protected] 1
Medical Oncology Unit, ASST Settelaghi, Varese, Italy
2
Department of Medicine and Surgery, University of Insubria, Varese, Como, Italy
3
LARC Turin, Turin, Italy
is generally irreversible and persists even after cessation of chemotherapy [1]. The damage to the myoc
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