Does concomitant prophylactic therapy with metoprolol or enalapril reduce doxorubicin-induced cardiotoxicity in lymphoma patients?
Prophylactic treatment with metoprolol or enalapril did not significantly reduce doxorubicin-induced cardiotoxicity in lymphoma patients over 36 months, though a non-significant trend for benefit was seen with metoprolol.
Anthracyclines have contributed to a marked increase in survival in different types of cancer 1,2. Unfortunately, they are associated with dose-dependent cardiotoxicity and heart failure (HF) 3–8. Change to a weekly dosage schedule with slow infusions has been tested, a strategy that requires more frequent hospital visits and increased storage resources7,9. Liposomal anthracycline formulations with reduced drug exposure and lower plasma concentrations may still be cardiotoxic at higher cumulative doses 10. Beta-blockers and angiotensin converting enzyme(ACE) inhibitors have been shown to reduce anthracycline-induced cardiotoxicity,but have not been tested in long-term prospective, randomized,controlled studies with well defined cardiotoxicity criteria and careful cardiac function monitoring 11–16. We investigated doxorubicin-induced clinical or subclinical cardiotoxicity in lymphoma patients after concomitant prophylactic therapy with metoprolol or enalapril or no concomitant treatment. We examined whether cardiotoxicity was related to the treatment or any other variable. We found that HF was less frequent under concomitant treatment than no treatment, especially in the metoprolol group, but the differences were not significant. No association was found between the presence of cardiotoxicity and concomitant treatment or other variable apart of age that had a significant impact. The marginal benefit seen with metoprolol should be investigated further.
Georgakopoulos et al. (Mon,) studied this question.