Treatment with common heart drugs during cancer therapy reduced cardiotoxicity for patients with breast and hematological cancer, according to research presented at EuroEcho 2019. The research showed that for every 10 patients that were treated with heart drugs, 1 case of cardiotoxicity could be avoided.
The research analyzed a total of 913 participants from 9 different studies, who received chemotherapy for breast and hematological malignancies. In total, 337 (37%) received beta-blockers, 152 (17%) received angiotensin converting enzyme inhibitors/angiotensin II receptor antagonists (ACEI/ARB), 45 (5%) received beta-blockers plus ACEI and 379 (41%) were controls. A total of 108 cases (12%) developed cardiotoxicity (follow up, 112 months), with patients that received the cardioprotective treatment showing a significantly lower relative risk when compared with controls (RR, 0.381; 95% CI, 0.160-0.911; P = 0.030).
“Our meta-analysis supports the use of cardioprotective treatment (beta-blockers or angiotensin converting enzyme inhibitors) in patients undergoing cardiotoxic chemotherapy (especially anthracyclines or trastuzumab),” said Sergio Moral, MD, PhD, of Hospital Universitari Josep Trueta and Hospital Santa Caterina, Girona, Spain. “Thus, primary prevention therapy should be considered, particularly in patients with risk factors for cardiotoxicity.”
The meta-analysis included 9 studies from January 2005 to April 2019 and the main cancer therapy administered in each of the studies was anthracycline chemotherapy. Cardiotoxicity was defined by the researchers as the drop of the left ventricular ejection fraction below 50% or greater than 10% and/or clinical heart failure during the first year of follow-up.
A subgroup analysis showed a nonsignificant tendency for both treatments to have a cardioprotective effect with beta-blockers (RR, 0.477; 95% CI, 0.178-1.275; P = 0.140) and ACEI/ARB (RR, 0.283; 95% CI, 0.0272-0.982; P = 0.293), compared with controls. There was no difference between treatments in those studies comparing them (RR, 0.743; 95% CI, 0.325-1.698; P = 0.481).
The frequency of cardiovascular side effects and the incidence of associated cardiotoxicity from chemotherapy is a continued issue for cancer treatment, and one that prompted the researchers to conduct the study.
“Cardiac dysfunction is a serious adverse effect of certain cancer therapies, ranging between 3% and 48%, depending on dose and duration of exposure, among anthracycline-treated patients,” said Moral. “Separately, trastuzumab (Herceptin)-treated patients present up to 18% of left ventricular dysfunction dose-independence and 4% of them develop heart failure. This complication decreases the quality of life of our patients and worsens the clinical prognosis, making primary prevention a main draw for cardio-oncology.”
Moral noted a couple of limitations to the research, primarily that the majority of studies were small and restricted to single center experiences. Additionally, the study left some questions unanswered, such as which subgroup of patients were most susceptible to cardiotoxicity, which cardioprotective treatment was most beneficial, and what would be the optimal dose/duration of any treatment.
The researchers called for further trials to investigate cardioprotective strategies to answer some of these questions.
Still, Moral believes the findings could lay the groundwork for changes in cardioprotective treatment. “Our findings may have impact in the primary prevention of cardiotoxicity,” Moral said. “They could change the usual clinical practice since beta-blockers and/or angiotensin converting enzyme inhibitors are not usually prescribed in daily practice.”
Moral S, Coma N, Eraso A, et al. Cardioprotective effects of angiotensin converting enzyme inhibitors and beta-blockers in the primary prevention of cardiotoxicity: systematic review and meta-analysis of randomized studies. In: Proceedings from European Society of Cardioology; December 4 – December 7, 2019. Vienna, Austria. Abstract P367.