Dapagliflozin improved LVGLS by 2.133 units compared to non-dapagliflozin controls at 3 months in breast cancer patients with type 2 diabetes receiving doxorubicin therapy (p < 0.001).
Observational (n=60)
No
Does dapagliflozin improve echocardiographic and biomarker surrogates of cardiotoxicity in newly diagnosed breast cancer patients with type 2 diabetes receiving doxorubicin?
Dapagliflozin may offer short-term cardioprotective benefits by preserving left ventricular global longitudinal strain and reducing NT-proBNP in diabetic breast cancer patients undergoing doxorubicin chemotherapy.
Effect estimate: Mean difference in LVGLS between groups +2.133 (95% CI +1.346 to +2.921) (95% CI +1.346 to +2.921)
Absolute Event Rate: -18.6% vs -16.47%
p-value: p=<0.001
Aim This study aimed to evaluate the risk of doxorubicin-induced cardiotoxicity in newly diagnosed breast cancer patients with type 2 diabetes receiving dapagliflozin in addition to metformin, using echocardiographic methods, and to investigate the potential cardioprotective effects of dapagliflozin. Materials and methods In this prospective observational study, a total of 60 newly diagnosed breast cancer patients with type 2 diabetes were enrolled. Thirty patients who had been treated with metformin and subsequently received dapagliflozin in addition to metformin during doxorubicin therapy constituted the dapagliflozin group. The non-dapagliflozin group consisted of 30 patients who, while continuing metformin, were initiated on another oral antidiabetic agent (excluding dapagliflozin) alongside doxorubicin therapy. N-terminal pro-B type natriuretic peptide (NT-proBNP), left ventricular ejection fraction (LVEF), and left ventricular global longitudinal strain (LVGLS) were measured at baseline and at the 3rd month of treatment. Between-group baseline characteristics were compared using the independent samples t-test for continuous variables. Within-group changes from baseline to 3 months were analyzed with paired t-tests. Between-group comparisons of 3-month outcomes and changes (ΔLVEF, ΔLVGLS, ΔNT-proBNP) were also conducted using independent samples t-tests. To evaluate the independent effect of dapagliflozin on LVGLS, multivariable linear regression analysis was performed. Model fit was reported with adjusted R², F-statistics and 95% confidence intervals. Results In the non-dapagliflozin group, LVEF and NT-proBNP levels showed no significant differences between baseline and post-treatment; however, LVGLS values significantly deteriorated. In contrast, the dapagliflozin group demonstrated a significant increase in LVEF (− 2.000 95% CI − 2.392, − 1.608) and LVGLS (+ 1.367 95% CI + 1.159, + 1.574), as well as a marked reduction in NT-proBNP levels (+ 64.933 95% CI + 57.902, + 71.964) after 3 months of treatment (p < 0.001). At the third month, the dapagliflozin group exhibited significantly better LVGLS (+ 2.133 95% CI + 1.346, + 2.921) and lower NT-proBNP levels (+ 57.000 95% CI + 28.302, + 85.698) compared with the non-dapagliflozin group (p < 0.001). Multivariable linear regression analysis confirmed that dapagliflozin use was independently associated with significant improvement in LVGLS at 3 months. Conclusion In conclusion, dapagliflozin was associated with more favorable short-term surrogate changes in LVGLS and NT-proBNP during doxorubicin therapy. The favorable changes observed in LVEF, LVGLS, and NT-proBNP parameters suggest that dapagliflozin may be considered a potential cardioprotective agent and incorporated into preventive strategies against chemotherapy-related cardiotoxicity in diabetic patients. These hypothesis-generating findings require confirmation in larger randomized trials powered for clinical endpoints with longer follow-up. Clinical trial registration Not applicable.
Ozturk et al. (Sat,) conducted a observational in Newly diagnosed breast cancer patients with type 2 diabetes on metformin therapy undergoing doxorubicin chemotherapy (n=60). Dapagliflozin vs. Other oral antidiabetic agents (excluding dapagliflozin) plus metformin was evaluated on Change in left ventricular global longitudinal strain (LVGLS) at 3 months of doxorubicin therapy (Mean difference in LVGLS between groups +2.133 (95% CI +1.346 to +2.921), 95% CI +1.346 to +2.921, p=<0.001). Dapagliflozin improved LVGLS by 2.133 units compared to non-dapagliflozin controls at 3 months in breast cancer patients with type 2 diabetes receiving doxorubicin therapy (p < 0.001).