Role of cardioprotective therapy for prevention of cardiotoxicity with chemotherapy: A systematic review and meta-analysis

Kalam, Kashif and Marwick, Thomas H. (2013) Role of cardioprotective therapy for prevention of cardiotoxicity with chemotherapy: A systematic review and meta-analysis. European Journal of Cancer, 49 13: 2900-2909. doi:10.1016/j.ejca.2013.04.030


Author Kalam, Kashif
Marwick, Thomas H.
Title Role of cardioprotective therapy for prevention of cardiotoxicity with chemotherapy: A systematic review and meta-analysis
Journal name European Journal of Cancer   Check publisher's open access policy
ISSN 0959-8049
1879-0852
Publication date 2013-01-01
Year available 2013
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1016/j.ejca.2013.04.030
Open Access Status DOI
Volume 49
Issue 13
Start page 2900
End page 2909
Total pages 10
Place of publication Kidlington, Oxford, United Kingdom
Publisher Pergamon
Language eng
Subject 1306 Cancer Research
2730 Oncology
Abstract Cardiotoxicity is a well-recognised complication of chemotherapy with anthracycline and/or trastuzumab, and its prevention remains an important challenge in cancer survivorship. Several successful preventative strategies have been identified in animal trials. We sought to assemble the clinical evidence that prophylactic pharmacological interventions could prevent left ventricular (LV) dysfunction and heart failure in patients undergoing chemotherapy. Methods We undertook a systemic review of the evidence from randomised trials and observational studies where a prophylactic intervention was compared with a control arm in patients with a normal ejection fraction and no past history of heart failure. The primary outcome was development of heart failure (HF), a drop in ejection fraction (EF) or both. A random-effects model was used to combine relative risks (RR) and 95% confidence intervals (CIs), and a meta-regression was undertaken to assess the impact of potential covariates. Findings Data were collated from 14 published articles (n = 2015 paediatric and adult patients) comprising 12 randomised controlled trials and two observational studies. The most studied chemotherapeutic agents were anthracyclines, and prophylactic agents included dexrazoxane, statins, beta-blocker and angiotensin antagonists. There were 304 cardiac events in the control arm compared to 83 in the prophylaxis arm (RR = 0.31 [95% CI: 0.25-0.39], p < 0.00001). Cardiac events were reduced with dexrazoxane (RR = 0.35 [95% CI 0.27-0.45], p < 0.00001), beta-blockade (RR = 0.31 [95% CI 0.16-0.63], p = 0.001), statin (RR = 0.31 [95% CI 0.13-0.77], p = 0.01) and angiotensin antagonists (RR = 0.11 [95% CI 0.04-0.29], p < 0.0001). Interpretation Prophylactic treatment with dexrazoxane, beta-blocker, statin or angiotensin antagonists appear to have similar efficacy for reducing cardiotoxicity.
Keyword Anthracycline
Cancer chemotherapy
Cardioprotection
Cardiotoxicity
Trastuzumab
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Non HERDC
School of Medicine Publications
 
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Created: Tue, 25 Feb 2014, 23:38:52 EST by Matthew Lamb on behalf of Medicine - Princess Alexandra Hospital