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Preventive Strategies for Anthracyclines and Trastuzumab induced Cardiotoxicity: A systematic review and meta-analysis
Session:
Posters - K. Cardiovascular Disease In Special Populations
Speaker:
Cátia Costa Oliveira
Congress:
CPC 2021
Topic:
K. Cardiovascular Disease In Special Populations
Theme:
30. Cardiovascular Disease in Special Populations
Subtheme:
30.6 Cardio-Oncology
Session Type:
Posters
FP Number:
---
Authors:
Cátia Costa Oliveira; Rui Campos; Carlos Braga; Vitor Hugo Pereira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Background: Despite the widespread use of anthracyclines (ANT) and anti-HER2 agents as trastuzumab (TZB) in chemotherapy schemes, it is known the potential cardiotoxic effects that can limit the intensity and duration of treatments.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Aims: To study the benefit of drugs commonly used to treat heart failure with reduced ejection fraction or drugs known for an antioxidative effect on the prevention of ANT and TZB induced cardiotoxicity.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Methods: an extensive search was made in PubMed, Embase and Cochrane trials, from inception to November 2020 for randomized controlled trials, where the drugs mentioned were given to adult patients treated with ANT and/or TZB. The features considered to evaluate cardiac function were Left Ventricular Ejection Fraction (LVEF), Global Longitudinal Strain, E/A ratio, E/e’ ratio, Left Atrium diameter, BNP/NT-pro-BNP and Troponin I. Subgroup analysis were made accounting for combinations of ANT and/or TZB</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Results: 24 randomized controlled trials were included and a total of 3159 participants were included in the studies (94% were women). A meta-analysis showed betablockers to lower E/A ratio (combined effect of 0,12 decrease (95% CI:[0,05; 0,19], I 2 =11%), and did not show any effect on LVEF, except perhaps for nebivolol, which in one study demonstrated a mean difference of 6,30% [3,32; 9,28](p<0,05) between groups. Angiotensin Conversion Enzyme Inhibitors and Angiotensin Receptor Antagonists did not show any protective effect. Rosuvastatin also showed to preserve LVEF and left atrium diameter and Spironolactone showed to preserve LVEF and E/A and E/e’ ratio, however with only one trial each. Dexrazoxane also showed to reduce the incidence of cardiac events and preserve LVEF with a combined risk ratio of0,28 (95% CI: [0,16; 0,47], I 2 =9%).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Conclusions: Prophylactic administration of either beta-blockers, spironolactone, rosuvastatin or dexrazoxane may prevent the development of ANT and TZB cardiotoxicity and allow for fewer treatment interruptions and a better long-term prognosis of cancer patients.</span></span></p>
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