Cardioprotective Effects of Carvedilol in Inhibiting Doxorubicin-induced Cardiotoxicity

Nabati, Maryam; Janbabai, Ghasem; Baghyari, Saideh; Esmaili, Khadige; Yazdani, Jamshid

doi:10.1097/fjc.0000000000000470

Cited by 81 publications

(84 citation statements)

References 15 publications

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“…The labeling of doxorubicin and epirubicin recommends repeated assessment of cardiac function (Table ) . Coadministration of anthracyclines with a beta blocker, angiotensin‐converting‐enzyme (ACE) inhibitor, or angiotensin receptor blocker may preserve some aspects of cardiac function, as shown in patients with a recently diagnosed malignancy treated with anthracyclines, although some conflicting results have been observed . Overall, identification of risk factors for adverse cardiac events (see below), reducing those risk factors if possible, and appropriate monitoring for cardiac effects are required.…”

Section: Resultsmentioning

confidence: 99%

Prevention, Monitoring, and Management of Cardiac Dysfunction in Patients with Metastatic Breast Cancer

et al. 2019

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Cardiac monitoring is becoming an important part of breast cancer care. Breast cancer and cardiovascular disease (CVD) share many common risk factors, and it is estimated that by the median age of diagnosis, many patients with breast cancer will have established or subclinical CVD. In addition, a number of treatments for metastatic breast cancer are known to have cardiac effects. As such, there is a clear need to prevent, identify, and effectively manage cardiovascular events in patients with breast cancer. Current clinical practice for patients with metastatic breast cancer involves a comprehensive set of assessments to ensure efficacy and safety of treatment. Adding cardiac monitoring to the assessments already required for patients with breast cancer may improve survival and quality of life. Currently, cardiac monitoring is recommended for several breast cancer treatments, and guidelines related to cardiac monitoring are available. Here, we review the risk of CVD in patients with breast cancer, providing an overview of the cardiac events associated with standard therapies for metastatic breast cancer. We also assess the current clinical recommendations relating to cardiac monitoring, and practical management strategies for oncologists. Cardio‐oncology is a growing medical subspecialty that promotes the need for effective cancer therapy while minimizing cardiac effects. Integrating cardiac monitoring into routine clinical practice may safeguard patients with metastatic breast cancer against adverse cardiac effects. Implications for Practice This review details the common risk factors associated with cardiovascular disease that are frequently observed in patients with metastatic breast cancer, as well as the adverse cardiac effects of many therapies that are commonly prescribed. The review also provides a rationale for routine and comprehensive cardiovascular assessment of all patients at baseline, and during and after therapy depending on the treatment and presence of risk factors for cardiovascular disease. The medical discipline of cardio‐oncology is increasingly being recognized as an important part of clinical practice to ensure effective cancer therapy while maintaining cardiac health.

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Section: Resultsmentioning

confidence: 99%

Prevention, Monitoring, and Management of Cardiac Dysfunction in Patients with Metastatic Breast Cancer

et al. 2019

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“…E. (2014) [26]12.5BC40 (100%)40 (100%)54.3 ± 9.352.9 ± 11.2535.6523.366.0 ± 6.165.0 ± 4.56M. N. (2017) [27]Average 6.71 ± 1.65BC46 (100%)45 (100%)47.57 ± 8.7547.1 ± 12.17359.91348.5658.72 ± 4.6961.13 ± 4.976M. A.…”

Section: Resultsmentioning

confidence: 99%

“…The Galbraith plot revealed that the substantial heterogeneity came from the two studies by N. K. et al [24] and M. N. et al [27]. The exclusion of the study by N. K. et al reduced I 2 from 86 to 67% (MD, 1.74; 95% CI, − 0.18 to 3.66; P = 0.08).…”

Section: Resultsmentioning

confidence: 99%

“…E. [26]00Interrupted chemotherapy due to cardiotoxicity00M. N. [27]1 (2%)0LVEF < 40%2 (4%)3 (7%)R. S. [29]2 (9%) [12.5 mg carvedilol]4 (18%)Systolic cardiomyopathy (no specification)5 (23%) [12.5 mg carvedilol]1 (5%) [25 mg carvedilol]5 (23%)1 (4%) [25 mg carvedilol]Diastolic cardiomyopathy (no specification)3 (14%) [12.5 mg carvedilol]3 (14%) [25 mg carvedilol]5 (23%)M.…”

Section: Resultsmentioning

confidence: 99%

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Protective role of beta-blockers in chemotherapy-induced cardiotoxicity—a systematic review and meta-analysis of carvedilol

et al. 2018

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Some randomized controlled trials (RCTs) have tested the efficacy of beta-blockers as prophylactic agents on cancer therapy-induced cardiotoxicity; however, the quality of this evidence remains undetermined. This systematic review and meta-analysis study aims to evaluate the prophylactic effects of beta-blockers, especially carvedilol, on chemotherapy-induced cardiotoxicity. RCTs were identified by searching the MEDLINE (PubMed), Embase (OvidSP), Cochrane CENTRAL (OvidSP), etc., until December 2017. Inclusion criteria were randomized clinical trial and adult cancer patients started beta-blockers before chemotherapy. We evaluated the mean differences (MD) by fixed- or random-effects model and the odds ratio by Peto’s method. Primary outcome was the left ventricular ejection fraction (LVEF) of patients after chemotherapy, and secondary outcomes were all-cause mortality, clinically overt cardiotoxicity, and other echocardiographic measurements. In total, we included six RCTs that used carvedilol as a prophylactic agent in patients receiving chemotherapy. The LVEF was not significantly distinct between those using carvedilol and placebo after chemotherapy (MD, 1.74; 95% confidence interval (CI), − 0.18 to 3.66; P = 0.08). The incidence of clinically overt cardiotoxicity was lower in the carvedilol group compared with the control group (Peto OR, 0.42; 95% CI, 0.20–0.89; P = 0.02). Furthermore, after chemotherapy, the LV end-diastolic diameter did not increase in the carvedilol group compared with the placebo group (MD, − 1.41; 95% CI, − 2.32 to − 0.50; P = 0.002). The prophylactic use of carvedilol exerted no impact on the early asymptomatic LVEF decrease but seemed to attenuate the frequency of clinically overt cardiotoxicity and prevent ventricular remodeling. Electronic supplementary material The online version of this article (10.1007/s10741-018-9755-3) contains supplementary material, which is available to authorized users.

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“…In a similar study, the same investigators randomly assigned 91 women recently diagnosed with breast cancer and treated with anthracyclines to either carvedilol or placebo and evaluated changes in LVEF 6 months after diagnosis [96]. Median reduction in LVEF from baseline was 10% in the placebo group and zero in the carvedilol group (P < 0.001) [96].…”

Section: Clinical Studies In Adultsmentioning

confidence: 99%

Strategies to prevent anthracycline-induced cardiotoxicity in cancer survivors

et al. 2019

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Cancer diagnostics and therapies have improved steadily over the last few decades, markedly increasing life expectancy for patients at all ages. However, conventional and newer anti-neoplastic therapies can cause short-and long-term cardiotoxicity. The clinical implications of this cardiotoxicity become more important with the increasing use of cardiotoxic drugs. The implications are especially serious among patients predisposed to adverse cardiac effects, such as youth, the elderly, those with cardiovascular comorbidities, and those receiving additional chemotherapies or thoracic radiation. However, the optimal strategy for preventing and managing chemotherapyinduced cardiotoxicity remains unknown. The routine use of neurohormonal antagonists for cardioprotection is not currently justified, given the marginal benefits and associated adverse events, particularly with long-term use. The only United States Food and Drug Administration and European Medicines Agency approved treatment for preventing anthracycline-related cardiomyopathy is dexrazoxane. We advocate administering dexrazoxane during cancer treatment to limit the cardiotoxic effects of anthracycline chemotherapy.

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Cardioprotective Effects of Carvedilol in Inhibiting Doxorubicin-induced Cardiotoxicity

Abstract: Prophylactic use of carvedilol may inhibit the development of anthracycline-induced cardiotoxicity, even at low doses.

Cited by 81 publications

References 15 publications

Prevention, Monitoring, and Management of Cardiac Dysfunction in Patients with Metastatic Breast Cancer

Prevention, Monitoring, and Management of Cardiac Dysfunction in Patients with Metastatic Breast Cancer

Protective role of beta-blockers in chemotherapy-induced cardiotoxicity—a systematic review and meta-analysis of carvedilol

Strategies to prevent anthracycline-induced cardiotoxicity in cancer survivors

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