Heart failure from cancer therapy: can we prevent it?

Area of Science:

• Cardio-oncology
• Cardiovascular disease
• Pharmacology

Background:

• Chemotherapy, particularly anthracycline-based regimens, is a cornerstone cancer treatment but can cause cardiotoxicity, leading to decreased left ventricular function and impaired prognosis.
• Prevention and management of chemotherapy-induced cardiotoxicity are critical for improving patient outcomes.

Purpose of the Study:

• To conduct a meta-analysis assessing the efficacy of beta-blockers or angiotensin-converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARBs) in preventing cardiotoxicity during chemotherapy.

Main Methods:

• Systematic literature search of randomized controlled trials (RCTs) from major databases (PubMed, Cochrane, EMBASE, Web of Science) up to February 2019.
• Included RCTs focused on cancer patients receiving beta-blockers or ACE inhibitors/ARBs for cardiotoxicity prevention, comparing left ventricular ejection fraction (LVEF) with control groups.
• Excluded studies on combination cardioprotective therapies; primary endpoint was prevention of LVEF decrease, assessed by echocardiography or cardiac MRI.

Main Results:

• Meta-analysis revealed a moderate yet significant benefit of beta-blockers (n=769) and ACE inhibitors/ARBs (n=581) in preserving LVEF in patients undergoing anthracycline-based chemotherapy.
• The mean LVEF difference was 2.57% for beta-blockers (P=0.009) and 4.71% for ACE inhibitors/ARBs (P=0.03).
• Significant heterogeneity was observed across studies, indicating variability in beneficial effects.

Conclusions:

• Systematic evidence supports the use of beta-blockers or ACE inhibitors/ARBs for cardioprotective prevention during chemotherapy, though variability exists.
• Further research is warranted for other neurohumoral drugs, such as spironolactone, and lipid-lowering agents to enhance cardio-oncology patient protection.