Liposomal doxorubicin and epirubicin plus dexrazoxane had superior cardioprotective effects compared to doxorubicin (OR 3.75; 95% CI 2.46-5.70 and OR 3.66; 95% CI 1.09-12.33, respectively).
Meta-Analysis (n=3,484)
Do alternative anthracycline strategies (epirubicin, liposomal doxorubicin, or addition of dexrazoxane) reduce cardiotoxicity and maintain efficacy compared to doxorubicin in patients with breast cancer?
Liposomal doxorubicin or epirubicin plus dexrazoxane offer the most favorable balance of reduced cardiotoxicity and preserved efficacy in breast cancer patients compared to standard doxorubicin.
Odds Ratio: 3.75 (95% CI 2.46–5.7)
The effects of anthracycline-based chemical therapies on breast cancer are controversial and inconclusive. We undertook a network meta-analysis to assess the cardiotoxicity and effects of anthracycline therapies in breast cancer. The PubMed, Embase, and Cochrane databases up to August 2018 were reviewed. We identified 19 randomized clinical trials including 3,484 patients with breast cancer which assessed both cardiotoxicity and the effects of anthracycline-based therapies. Eligible studies included the following five treatment strategies: doxorubicin, epirubicin, liposomal doxorubicin (LD), doxorubicin + dexrazoxane (DD), and epirubicin + dexrazoxane (ED). In a direct meta-analysis, epirubicin, LD, DD, and ED had significantly superior cardioprotective effects compared with doxorubicin with odds ratios and 95% CIs of 1.64 (1.04, 2.57), 3.75 (2.46, 5.70), 2.88 (1.93, 4.29), and 3.66 (1.09, 12.33), respectively. Doxorubicin showed no significant difference of response rate compared with epirubicin or LD or DD, respectively. In a network meta-analysis, the ranking order of cardiotoxicity was doxorubicin (worst), epirubicin, DD, LD, and ED (best). The ranking order of the response rate was LD (best), doxorubicin, epirubicin, ED, and DD (worst). The most favorable balance between benefit and risk was shown for ED (best) followed by LD, DD, epirubicin, and doxorubicin. In conclusion, LD or ED is the suitable anthracycline treatment for breast cancer in consideration of both cardiotoxicity and efficacy.
Mao et al. (Tue,) conducted a meta-analysis in breast cancer (n=3,484). Liposomal doxorubicin (LD) and epirubicin + dexrazoxane (ED) vs. Doxorubicin was evaluated on Cardioprotective effects (cardiotoxicity) (OR 3.75, 95% CI 2.46-5.70). Liposomal doxorubicin and epirubicin plus dexrazoxane had superior cardioprotective effects compared to doxorubicin (OR 3.75; 95% CI 2.46-5.70 and OR 3.66; 95% CI 1.09-12.33, respectively).