Anthracycline-associated cardiotoxicity in adults: systematic review on the cardioprotective role of beta-blockers

Abstract

SUMMARY OBJECTIVES This study aimed at assessing the role of beta-blockers on preventing anthracycline-induced cardiotoxicity in adults. METHODS A systematic review was performed on electronic databases, including relevant studies that analysed beta-blockers as cardioprotective agents before the use of anthracyclines by adult oncologic patients. RESULTS After application of eligibility and selection criteria, eight articles were considered as high quality, complying with the proposed theme; all eight clinical trials, four of them placebo-controlled, with a total number of 655 patients included. From this sample, 281 (42.9%) used beta-blocker as intervention, and carvedilol was the most frequent (167 patients – 25.5%). Six studies were considered positive regarding the cardioprotection role played by beta-blockers, although only four demonstrated significant difference on left ventricle ejection fraction after chemotherapy on groups that used beta-blockers compared to control groups. Carvedilol and nebivolol, but not metoprolol, had positive results regarding cardioprotection. Other beta-blockers were not analysed in the selected studies. CONCLUSIONS Despite the potential cardioprotective effect of beta-blockers, as demonstrated in small and unicentric clinical trials, its routine use on prevention of anthracycline-associated cardiotoxicity demands greater scientific evidence.

Prophylactic, single-drug cardioprotection in a comparative, experimental study of doxorubicin-induced cardiomyopathy

“…DOX treatment significantly increased systolic BP of the animals compared to CON (157. 69 , p = 0.0037/p = 0.0027 (ACEI vs. CON), p = 0.0012/p = 0.0012 (ACEI vs. D-CON), p = 0.0083/p = 0.0014 (ACEI vs. BB), p = 0.0015/p = 0.0421 (ACEI vs. AA)] ( Fig. 2d, e , p = 0.001 (BB vs. CON), p = 0.0026 (BB vs. D-CON), p = 0.011 (BB vs. ACEI), p = 0.0055 (BB vs. AA)] (Fig.…”

“…On the other hand, no significant haemodynamic consequence of the eplerenone treatment could be seen in the animals at the applied dose (6.25 mg/kg). Previously, several smaller clinical trials [31-34, 57, 58, 66] and some meta-analyses [67][68][69][70] have investigated the prophylactic effects of BBs and ACEIs applied alone or in combination to prevent AC cardiotoxicity, however, their results were not always consistent. Although some study groups demonstrated the protective effects of the applied agent on the LV EF [31,33,34,66], others could not confirm the superiority of the study drug compared to placebo [32,57,58].…”

The Relationship Between Anti-Hypertensive Drugs and Cancer: Anxiety to be Resolved in Urgent

“…Charak et al (Charak et al, 2018) also suggested that BBs were associated with better specific cancer survival. Furthermore, the results of a systematic review of eight high-quality studies (Barbosa et al, 2018) indicated that BBs had potential protective effects on the heart. Additionally, for early-stage cancer treated with surgery, BBs could prolong the survival period (Choi et al, 2014).…”

Abordaje de la enfermedad cardiovascular en mujeres con cáncer de mama. Posición de la Asociación Nacional de Cardiólogos de México (ANCAM)

“…164 In different studies it has shown improvement in GLS more than in LVEF; in others, lower release of TnI and better diastolic function. 165,166 Nevibolol 167 and bisoprolol have some benefit; 165 metoprolol has a neutral effect 162 on results and propranolol has a cardiotoxic role. 165,166 • Statins.…”

“…165,166 Nevibolol 167 and bisoprolol have some benefit; 165 metoprolol has a neutral effect 162 on results and propranolol has a cardiotoxic role. 165,166 • Statins. There is evidence of its favorable effect on the prognosis with reduction in the BC recurrence at 5 years (0.67 for users vs non-users 95% CI, 0.39 to 1.13); 168 as well as in the preservation of ventricular function.…”