Prevention of Chemotherapy-Induced Cardiotoxicity: Efficacy of Carvedilol and Enalapril in High-Risk Cancer Patients

Introduction: Chemotherapy with anthracyclines and other cardiotoxic agents significantly increases the risk of left ventricular dysfunction, especially in patients with pre-existing cardiovascular risk factors. Preventive pharmacological strategies using cardioprotective drugs such as carvedilol and enalapril have shown promising results in reducing cardiotoxic events. Objective: To systematically review the efficacy of carvedilol and enalapril in the prevention of chemotherapy-induced cardiotoxicity in high-risk cancer patients. Secondary objectives included analysis of safety, tolerability, and long-term outcomes. Methods: A systematic review was conducted using PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ClinicalTrials.gov, and ICTRP. Studies published in the last five years were included, with extension up to ten years if fewer than ten eligible studies were available. PRISMA methodology was followed, risk of bias was assessed with RoB 2 and ROBINS-I, and certainty of evidence was evaluated using GRADE. Results and Discussion: From 1,486 initial records, 32 studies were included. Randomized controlled trials and cohort studies demonstrated that carvedilol and enalapril reduced left ventricular ejection fraction decline, troponin elevation, and natriuretic peptide increases. The combination of these drugs appeared particularly effective in high-risk groups, without compromising oncological efficacy. Conclusion: Carvedilol and enalapril are safe and effective preventive strategies against chemotherapy-induced cardiotoxicity. Their integration into cardio-oncology protocols should be considered for high-risk patients, with individualized monitoring and long-term follow-up.