Is it possible to prevent chemotherapy-induced heart failure with cardiovascular drugs - the review of the current clinical evidence

Q: What is the clinical evidence from this study?

Study design: Review. Population: Chemotherapy-induced cardiotoxicity and heart failure in oncological patients. Intervention: Cardiovascular cardioprotective drugs (beta-blockers such as carvedilol and nebivolol, ACE inhibitors such as enalapril, ARBs such as candesartan, aldosterone antagonists, statins, and trimetazidine) vs. Placebo or control (standard oncology care without cardioprotective agents). Primary outcome: Prevention of chemotherapy-induced cardiotoxicity, left ventricular ejection fraction (LVEF) reduction, and heart remodeling.

Katarzyna Korzeniowska; Jerzy Jankowski; Artur Cieślewicz; Anna Jabłecka

doi:10.2147/tcrm.s215857

September 1, 2019Therapeutics and Clinical Risk ManagementOpen Access

Is it possible to prevent chemotherapy-induced heart failure with cardiovascular drugs - the review of the current clinical evidence

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Key result

Carvedilol, nebivolol, enalapril, and candesartan show the greatest promise in preventing chemotherapy-induced LVEF decline.

Why the study?

Do prophylactic cardiovascular drugs prevent chemotherapy-induced cardiotoxicity and heart failure in oncological patients undergoing anticancer treatment?

Key Points

To review clinical evidence on using cardiovascular medications to prevent chemotherapy-induced cardiotoxicity and heart failure in cancer patients.
Searched the PubMed database for clinical studies using terms including cardiotoxicity, prevention, RAA system drugs, β-blockers, ACEI, ARB, and statins.
Synthesized findings from randomized clinical trials evaluating cardiovascular agents administered before or during chemotherapy regimens such as anthracyclines.
In a randomized trial of breast cancer patients receiving anthracyclines, nebivolol 5 mg maintained LVESD (30.4±3.5 to 31.0±3.6 mm, p=0.20) and LVEDD (47.0±4.4 to 47.1±4.0 mm, p=0.93) with higher LVEF versus placebo (63.8±3.9% vs 57.5±5.6%, p=0.01).
A meta-analysis of 8 randomized controlled trials revealed carvedilol preserved left ventricular ejection fraction compared to placebo (mean difference: 2.41%).
Carvedilol, nebivolol, enalapril, and candesartan emerge as the most promising agents to counter cardiac remodeling and elevated resting heart rate, while statins represent an alternative if adverse reactions occur.

Structured PICO

Do prophylactic cardiovascular drugs prevent chemotherapy-induced cardiotoxicity and heart failure in oncological patients undergoing anticancer treatment?

P

Population

Oncological patients undergoing potentially cardiotoxic anticancer treatments, such as anthracyclines and trastuzumab, evaluated across clinical studies for primary prevention of chemotherapy-induced cardiotoxicity.

I

Intervention

Prophylactic cardiovascular drugs for cardioprotection, including beta-blockers (carvedilol, nebivolol, bisoprolol, metoprolol), ACE inhibitors (enalapril, perindopril), angiotensin receptor blockers (candesartan, telmisartan), aldosterone antagonists (spironolactone), statins (atorvastatin, simvastatin, rosuvastatin, pravastatin), trimetazidine, ranolazine, ivabradine, and coenzyme Q10.

C

Comparator

Placebo or standard oncological treatment without cardioprotective therapy in the reviewed trials.

O

Outcome

Prevention of chemotherapy-induced cardiotoxicity, left ventricular dysfunction (LVEF reduction), cardiac remodeling (LVEDD, LVESD), and heart failure.surrogate

Limitations

Heterogeneous and small-sized populations of patients across reviewed clinical trials
Patients were treated with various antitumor drugs that are cardiotoxic in different dosing regimens
Cardioprotective drugs used in clinical trials were administered in a wide range of doses
Heterogeneous and small-sized patient populations in existing clinical trials
Variability in antitumor drugs and cardiotoxic dosing regimens across studies
Wide range of doses used for cardioprotective drugs in clinical trials

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Implication

This review highlights that beta-blockers (carvedilol, nebivolol), ACE inhibitors (enalapril), and ARBs (candesartan) show promise in attenuating chemotherapy-induced LVEF decline and cardiac remodeling, supporting targeted prophylaxis and biomarker/imaging surveillance in high-risk oncology patients.

Abstract

Cardiovascular diseases and cancer are the most common death causes in the USA and Europe. Moreover, many patients suffer from both of these conditions - a situation which may result from cardiotoxicity of anticancer treatment. In order to reduce the severity of this adverse effect, various methods have been proposed, including the usage of new drug forms and less toxic analogs, omitting the combinations of potentially cardiotoxic drugs and introducing potential cardioprotective agents to the therapy. However, prevention of cardiotoxicity still seems to be insufficient. The article reviews the results of current studies on the use of cardiovascular drugs in the prevention of cardiotoxicity. Based on this knowledge, the most promising cardioprotective drugs seem to be carvedilol, nebivolol, enalapril, and candesartan, as they prevent heart remodeling and correct elevated resting heart rate, which directly affects mortality. Alternatively, in case of adverse reactions, statins might be considered.

Discussion

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Cite This Study

Korzeniowska et al. (2019) conducted a review in Chemotherapy-induced cardiotoxicity and heart failure in oncological patients. Cardiovascular cardioprotective drugs (beta-blockers such as carvedilol and nebivolol, ACE inhibitors such as enalapril, ARBs such as candesartan, aldosterone antagonists, statins, and trimetazidine) vs. Placebo or control (standard oncology care without cardioprotective agents) was evaluated on Prevention of chemotherapy-induced cardiotoxicity, left ventricular ejection fraction (LVEF) reduction, and heart remodeling. Carvedilol, nebivolol, enalapril, and candesartan are the most promising drugs to prevent heart remodeling and LVEF decline in patients receiving cardiotoxic chemotherapy.

synapsesocial.com/papers/6a89b473d42f68325a92dc52 https://doi.org/10.2147/tcrm.s215857

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Is it possible to prevent chemotherapy-induced heart failure with cardiovascular drugs - the review of the current clinical evidence

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Is it possible to prevent chemotherapy-induced heart failure with cardiovascular drugs - the review of the current clinical evidence

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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