Atorvastatin use ok in patients with lymphoma at high risk of cardiac dysfunction due to anthracycline: JAMA

USA: Findings from a recent double-blind clinical trial published in the Journal of the American Medical Association (JAMA) may support atorvastatin use in lymphoma patients at risk of cardiac dysfunction due to anthracycline treatment. 

The researchers revealed that atorvastatin, a commonly used cholesterol-lowering medication, lowered cardiac functional impairment in lymphoma patients treated with anthracyclines.

Anthracyclines have long been used to combat a range of cancers, but their potential impact on cardiac function has raised concerns. The study by  Thomas G. Neilan and colleagues shed light on a potential solution: Atorvastatin appears to mitigate the risk of cardiac dysfunction in lymphoma patients undergoing anthracycline-based chemotherapy. 

As cancer treatment advances, researchers continually seek ways to enhance patient outcomes while minimising side effects. A pivotal clinical trial involving 300 lymphoma patients receiving anthracycline-based chemotherapy has brought atorvastatin into focus as a potential solution. Conducted across 9 academic medical centres in the US and Canada, the trial aimed to ascertain whether atorvastatin could reduce the incidence of cardiac dysfunction-a known complication associated with anthracycline use.

● The trial enrolled 300 patients with lymphoma, with an average age of 50 years. Of these, 142 (47%) were women. Impressively, 95% (286 participants) completed the trial, underscoring the commitment to the study's objectives.

● The baseline mean left ventricular ejection fraction (LVEF), a crucial indicator of heart function, was 63% (with a standard deviation of 4.6%). After undergoing anthracycline-based chemotherapy, the follow-up LVEF dropped to 58% (with a standard deviation of 5.7%).

● 91% of participants demonstrated adherence to the study drug regimen, highlighting the importance of the trial's methodology. Among those who received atorvastatin, only 9% (13 out of 150) experienced a decline in LVEF of 10% or greater, compared to 22% (33 out of 150) in the placebo group.

● This remarkable difference underscores atorvastatin's potential in mitigating cardiac dysfunction induced by anthracycline-based chemotherapy. The trial's results were statistically significant, with a p-value of .002, reaffirming the strong correlation between atorvastatin use and the reduction of cardiac dysfunction risk.

● The odds of experiencing a decline in LVEF of 10% or more to a final value below 55% were almost three times greater for participants randomized to placebo compared to those receiving atorvastatin. This odds ratio of 2.9, with a 95% confidence interval of 1.4-6.4, emphasizes atorvastatin's protective effect.

● Atorvastatin also demonstrated efficacy in reducing the incidence of the secondary endpoint, a notable outcome. The study's thoroughness extended to the assessment of heart failure events and adverse effects.

● Over a 24-month follow-up period, 13 adjudicated heart failure events occurred, representing 4% of the study cohort. There was no discernible difference in the rates of incident heart failure between the two study groups (3% for atorvastatin and 6% for placebo), with a p-value of .26.

● The number of serious related adverse events was both low and consistent across the study groups.

Cancer treatments often come with complex challenges, and minimising adverse effects is a paramount goal. The discovery of atorvastatin's potential role in safeguarding cardiac function brings renewed hope to patients, physicians, and researchers alike. As medical science continues to explore innovative solutions, this revelation showcases the power of repurposing existing medications to revolutionise cancer care, offering a brighter and healthier future for those navigating the complexities of cancer treatment.

Reference:

Neilan, T. G., Quinaglia, T., Onoue, T., Mahmood, S. S., Drobni, Z. D., Gilman, H. K., Smith, A., Heemelaar, J. C., Brahmbhatt, P., Ho, J. S., Sama, S., Svoboda, J., Neuberg, D. S., Abramson, J. S., Hochberg, E. P., Barnes, J. A., Armand, P., Jacobsen, E. D., Jacobson, C. A., … Scherrer-Crosbie, M. (2023). Atorvastatin for anthracycline-associated cardiac dysfunction: The STOP-CA randomized clinical trial. JAMA: The Journal of the American Medical Association, 330(6), 528. https://doi.org/10.1001/jama.2023.11887.