Key result
Combined RAAS inhibitors and beta-blockers reduce CTRCD and mitigate LVEF decline in breast cancer patients.
Why the study?
Chemotherapy and targeted therapy for breast cancer cause cardiovascular side effects, creating a need for effective cardioprotection strategies to prevent cardiotoxicity.
Do cardioprotective strategies prevent cardiotoxicity and LVEF reduction in breast cancer patients receiving chemotherapy or targeted therapy?
Systematic Review
Do cardioprotective strategies prevent cardiotoxicity and LVEF reduction in breast cancer patients receiving chemotherapy or targeted therapy?
Combination therapy with RAAS inhibitors and beta-blockers attenuates chemotherapy-induced left ventricular dysfunction in breast cancer patients, though individual therapies showed mixed results.
Supports beta-blockers and RAAS inhibitors for cardioprotection in breast cancer therapy; reinforces evidence for preventing treatment-related cardiotoxicity.
Background: Breast cancer is the most prevalent malignancy among women on a global scale, affecting an average of 2.1 million individuals annually. In addition, several studies have shown that it is often treated using chemotherapy drugs and targeted therapy, but these treatment methods have been reported to have side effects on the cardiovascular system. This indicates that there is a need to develop new and effective strategies to prevent the associated side effects. Therefore, this systematic review aims to obtain cardioprotection strategies to prevent cardiotoxicity in breast cancer patients receiving chemotherapy or targeted therapy. Methods: Data collection was carried out using the online database PubMed with keywords ((cardioprotection) AND (breast cancer therapy) AND (cardiotoxic) OR (Cardiac dysfunction.)) From the initial search, a total of 150 studies were obtained, while articles that did not meet the eligibility criteria were excluded. Furthermore, the articles were reviewed using full-text reading, leading to the inclusion of nineteen in this systematic review. Results: A total of eleven studies evaluated the effect of cardio-protective drugs on Anthracycline (ANT), and nine assessed Trastuzumab. The results showed that eight studies used Beta-blocker (BB) as cardio-protective strategies, while one, one, three, two, one, one, and one utilized Angiotensin receptor blockers (ARB), ARB + Beta-blocker, ACE-inhibitor (ACE-I) + Beta-blocker, ACE-I/ARB/BB, spironolactone, statin, and Dexrazoxane (DZR), respectively. In large reports, the risk of CTRCD was reduced by the use of a combination of RAAS inhibitors and Beta-blockers. Furthermore, spironolactone, statins, and DZR mitigated the decrease in LVEF compared to the control group in small studies. Conclusions: Based on the results, chemotherapy decreased left ventricular ejection fraction (LVEF) and induced heart failure. Furthermore, the review showed that a combination of reninangiotensin-aldosterone system (RAAS) inhibitors and Beta-blockers reduced CTRCD. Future studies in larger settings were needed to investigate the efficacy of other strategies, such as statins, Spironolactone, exercise, and DZR.
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Laksono et al. (2023) conducted a systematic review in Breast cancer therapy-related cardiotoxicity. Cardioprotection strategies (RAAS inhibitors, Beta-blockers, statins, spironolactone, dexrazoxane) vs. Placebo or no intervention was evaluated on Reduction in mean LVEF by ≥10% or more from baseline. Cardioprotective strategies, particularly the combination of RAAS inhibitors and beta-blockers, reduced cancer-therapy-related cardiac dysfunction and mitigated left ventricular ejection fraction decline in breast cancer patients.
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