Efficacy of cardioprotective therapies in preventing cardiotoxicity in breast cancer patients treated with anthracyclines: A systematic review and meta-analysis.

Abstract

e15123 Background: Cancer therapy-related cardiac dysfunction (CTRCD), particularly in patients receiving anthracyclines (such as doxorubicin or epirubicin), is a major concern due to its potential to cause long-term cardiac damage. While a decrease in left ventricular ejection fraction (LVEF) has traditionally been used as a marker for initiating cardioprotective therapy, recent studies suggest that a reduction in global longitudinal strain (GLS) may be an earlier and more sensitive indicator of cardiovascular risk. This meta-analysis aims to evaluate the effectiveness of cardioprotective therapies, including angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARBs), beta-blockers, and neurohormonal antagonists, in preventing CTRCD in cancer patients undergoing chemotherapy with anthracyclines. Methods: PubMed, Embase, and Cochrane Library databases were searched for randomized controlled trials (RCTs) comparing the use of cardioprotective therapies (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, and neurohormonal antagonists) with standard care in cancer patients receiving anthracycline chemotherapy. Data were analyzed using a random-effects model, and the Odds Ratio (OR) and Mean Differences (MD) with 95% confidence intervals (CI) were calculated. P values >0.10 and I2 values >25% were considered to indicate significance for heterogeneity. Statistical analysis was performed using R, version 4.4.2. Results: 14 RCTs involving 2,255 breast cancer (BC) patients were included in the analysis, of whom 1,259 (55.83%) received cardioprotective therapies. A statistically significant difference was observed in adverse events (AEs), with the treatment showing a greater effect on the risk of AEs (OR 1.74; 95% CI 1.09 to 2.79; p = 0.02; I2: 58.6%). The AEs included Dizziness, Hypotension, Nausea, Constipation, Palpitation, Dyspnea, Diarrhea and Fatigue. Regarding CTRCD, no significant differences were observed between the groups (OR 0.38; 95% CI 0.10 to 1.46; p = 0.163; I2: 53.9%). Regarding changes in cardiac function parameters, no significant difference was observed in Delta GLS (MD -0.173; 95% CI -1.07 to 0.73; p = 0.70; I2: 95.4%). However, a significant difference was observed in Delta LVEF, with the treatment showing a greater improvement in left ventricular ejection fraction (MD 2.04; 95% CI 0.79 to 3.30; p = 0.001; I2: 94.3%). Similarly, the end-of-study LVEF was significantly higher in the treatment group (MD 2.02; 95% CI 1.04 to 3.01; p < 0.001; I2: 75.6%). Conclusions: This systematic review and meta-analysis demonstrated that cardioprotective therapies significantly improved LVEF in BC patients undergoing anthracycline chemotherapy. However, these therapies did not show a significant reduction in CTRCD or improvements in GLS.