Natural Progression of Left Ventricular Function Following Anthracyclines without Cardioprotective Therapy: A Systematic Review and Meta-Analysis

Abstract

Background: Anthracyclines form the backbone of many systemic chemotherapy regimens but dose-limiting cardiotoxicity can also lead to reduction in cardiac function and an increased risk of heart failure. Methods: This review was conducted in accordance with PRISMA guidelines and registered on PROSPERO (CRD42022373496). Results: 26 studies met the eligibility criteria including a total of 910 patients. Overall reduction in pooled mean left ventricular ejection fraction (LVEF) post‐anthracyclines in the placebo arms of included randomised-controlled trials was 4.6% (95% CI, 2.7 to 6.6). The trend in LVEF showed a progressive decline until approximately 180 days after which there was no significant change. Those receiving a cumulative anthracycline dose 300 mg/m2 experienced a more profound reduction. The risk of a 10% absolute decline in LVEF from baseline or decline to an LVEF below 50%, the overall pooled risk was 16% (95% CI: 11 to 21; I2 = 77%). Sensitivity analyses by baseline LVEF and trastuzumab treatment status did not yield significant differences. Conclusion: While the mean LVEF decline in patients without cardioprotective therapy was clinically small, a vulnerable subset experienced significant impairment. Further research to best identify those who benefit most from cardioprotective therapies when receiving anthracyclines are required.

Primary prevention of cardiotoxicity in paediatric cancer patients receiving anthracyclines: systematic review and meta-analysis of efficacy and safety profiles

“…Anthracyclines form the backbone of many chemotherapy regimens, treating more than half of all paediatric cancers 1 . Although survival rate has been steadily increasing across the years, anthracyclines are wellassociated with risk of cardiotoxicity, ranging from asymptomatic cardiac dysfunction to congestive heart failure [2][3][4] . Paediatric cancer survivors are five to ten times more likely to develop congestive cardiac failure compared to the general population 5,6 .…”