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Beta blockers, renin-angiotensin inhibitors may thwart anthracycline-induced cardiotoxicity

Jairia Dela Cruz
05 Dec 2018

Beta blockers (BBs) and/or renin-angiotensin inhibitors (RAIs) appear to be useful for preventing cardiotoxicity from anthracycline exposure, according to the results of a systematic review and meta-analysis presented at the European Society for Medical Oncology (ESMO) Asia 2018 Congress.

“Anthracyclines constitute the backbone of several chemotherapy regimens for various cancers. The use of these agents is constrained by the dose-limiting adverse effect of these drugs on cardiac function,” the investigators said.

“Two cornerstones of heart failure treatment, BB and RAI, have been used in studies to prevent cardiotoxicity from anthracycline exposure,” they continued.

To review and summarize extant evidence on the effectiveness of the said drugs in the prevention of anthracycline-induced cardiotoxicity, the investigators pooled data from 10 trials evaluating RAI and/or BB vs placebo as prophylaxis for cardiac events and left ventricular ejection fraction (LVEF) reduction in adult cancer patients (n=752) with normal ejection fraction and without heart failure symptoms on anthracycline.

Results showed that RAI and/or BB led to a statistically significant preservation of LVEF compared with placebo (mean difference [MD], 2.62 percent; 95 percent CI, 2.14–3.10; p<0.00001; I2, 90 percent). The benefits were consistent across the RAI (MD, 2.35 percent; 1.29–3.40; p<0.0001; I2, 88 percent) and BB (MD, 1.65 percent; 0.7–2.60; p=0.0007; I2, 92 percent) monotherapy arms. [ESMO Asia 2018, abstract 438P]

In a preplanned analysis of cardiac events, BBs and/or RAIs were also associated with a reduced risk of cardiac mortality or heart failure (relative risk, 0.27; 0.09–0.77; p=0.01; I2, 0 percent).

The present data indicate that BB and/or RAI can be used to preserve LVEF and reduce cardiac events among cancer patients receiving anthracyclines, the investigators said.

“Differences between populations studied explain the high heterogeneity from all the studies,” they added.

In the prevention and management of cancer therapy-induced left ventricular dysfunction, guidelines provide a useful framework: identify high-risk patients, treat their cardiovascular risk factors, modify anthracycline and radiation delivery, and administration of prophylaxis. [J Clin Oncol 2017;35:893-911; Eur Heart J 2016;37:2768-2801; Circulation 2013;128:e240-e327]

However, experts noted the need for continued study as new targeted cancer therapies become available clinically with undetermined short- and long-term cardiac effects. Also, there are currently no guidelines to direct which patients should or should not continue their cancer treatment, although the nature of the disease and treatment limit the ability to construct robust trials in this area. [https://www.acc.org/latest-in-cardiology/articles/2018/10/30/09/08/management-of-cancer-therapy-induced-lv-dysfunction]

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