The association between sodium-glucose cotransporter 2 inhibitor treatment and survival in patients with cancer therapy-related cardiac dysfunction

Anthracycline-based chemotherapy is a key component in the management of some cancers.1 Although effective, anthracyclines have been associated with cancer therapy-related cardiac dysfunction (CTRCD) and consequent cardiovascular adverse events.2 Studies have demonstrated that sodium–glucose cotransporter 2 inhibitors (SGLT2is) possess antioxidative and anti-inflammatory properties, in addition to enhancing cardiomyocyte viability in cancer patients.3 Furthermore, clinical studies have revealed that SGLT2i treatment has been associated with lower risk of cardiovascular events and hospitalization in cancer patients receiving anthracyclines.4,5 However, these studies have mainly focused on patients with Type 2 diabetes mellitus (T2DM), failing to demonstrate a consistent decrease in mortality, and did not focus on patients with CTRCD. Thus, evidence regarding the survival benefits of SGLT2i therapy in cancer patients with moderate to severe CTRCD, independent of T2DM, remains limited.4–6 This retrospective study assessed adult patients (>18 years old) who developed moderate or severe CTRCD secondary to anthracycline chemotherapy at three tertiary centres in the USA between 2002 and 2022. Cancer therapy-related cardiac dysfunction diagnosis was identified and graded according to the 2022 European Society of Cardiology guidelines.7 Patients with a decline in left ventricular ejection fraction (LVEF) underwent manual chart review to assess alternative aetiologies. Patients in whom the primary cause of LVEF decline was attributed to non–chemotherapy-related conditions were excluded. The study was approved by the Mayo Clinic Institutional Review Board, and informed consent was waived due to the retrospective nature of the study.