Sweden: A meta-analysis suggests that beta-blockers (BBs) and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARBs) may help in preserving LVEF in women undergoing breast cancer treatment with trastuzumab and/or anthracyclines. The study appears in the European Heart Journal.
Trastuzumab and anthracyclines are used often for the treatment of breast cancer. However, its use may impair myocardial function and reduce left ventricular ejection fraction (LVEF), potentially causing heart failure. Randomized controlled trials (RCTs) have evaluated the effects of BBs, ACEI/ARBs on trastuzumab- and anthracycline-associated cardiotoxicity.
Considering the above, Christian Lewinter, Heart Centre, Karolinska University Hospital, Karolinska Universitetssjukhuset Solna, Solna, Stockholm, Sweden, and colleagues aimed to assess the effect of BBs and ACEI/ARBs on LVEF in patients treated with either trastuzumab, anthracyclines, or both by conducting a meta-analysis of the RCTs in patients with breast cancer.
The researchers conducted primary and secondary analyses. The primary analysis was on the effect of BBs and ACEI/ARBs on LVEF in patients treated with either trastuzumab or anthracyclines. Secondary analysis was done investigating the effect of BBs or ACEI/ARBs on LVEF in trastuzumab and anthracycline treatments. Meta-analysis was conducted to estimate the mean difference (MD) in LVEF between intervention and placebo groups at follow-up.
The analysis included a total of nine RCTs (n = 1362). All patients were women.
Following were the study's key findings:
The baseline LVEF means varied between 59.5% and 66.0%. ACEI/ARB therapy irrespective of concomitant anthracycline or trastuzumab therapy was not significantly associated with improved LVEF compared to placebo (MD, 1.5).
In contrast, BB therapy preserved LVEF significantly better compared with placebo (MD, 2.4).
Both ACEI/ARBs and BBs were associated with preservation of LVEF compared to placebo in recipients of trastuzumab alone (MD, 2.3), but not anthracycline alone (MD, 1.9).
Whether LVEF was a primary outcome or not did not influence the MD, nor did the imaging modality.
To conclude, both BB and ACEI/ARB therapies were linked to the preservation of LVEF during trastuzumab and anthracycline-containing regimens as compared with placebo, suggesting both to be beneficial.
Reference:
Christian Lewinter, Torsten Holm Nielsen, Lars Robert Edfors, Cecilia Linde, John Martin Bland, M LeWinter, John G F Cleland, Lars Køber, Frieder Braunschweig, Agneta Mansson-Broberg, A systematic review and meta-analysis of beta-blockers and renin–angiotensin system inhibitors for preventing left ventricular dysfunction due to anthracyclines or trastuzumab in patients with breast cancer, European Heart Journal, 2021;, ehab843, https://doi.org/10.1093/eurheartj/ehab843