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Beta-blockers and RAAS inhibitors may prevent LVEF dysfunction due to breast cancer drugs: Study
Sweden: A meta-analysis suggests that beta-blockers (BBs) and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARBs) may help in preserving LVEF in women undergoing breast cancer treatment with trastuzumab and/or anthracyclines. The study appears in the European Heart Journal.
Trastuzumab and anthracyclines are used often for the treatment of breast cancer. However, its use may impair myocardial function and reduce left ventricular ejection fraction (LVEF), potentially causing heart failure. Randomized controlled trials (RCTs) have evaluated the effects of BBs, ACEI/ARBs on trastuzumab- and anthracycline-associated cardiotoxicity.
Considering the above, Christian Lewinter, Heart Centre, Karolinska University Hospital, Karolinska Universitetssjukhuset Solna, Solna, Stockholm, Sweden, and colleagues aimed to assess the effect of BBs and ACEI/ARBs on LVEF in patients treated with either trastuzumab, anthracyclines, or both by conducting a meta-analysis of the RCTs in patients with breast cancer.
The researchers conducted primary and secondary analyses. The primary analysis was on the effect of BBs and ACEI/ARBs on LVEF in patients treated with either trastuzumab or anthracyclines. Secondary analysis was done investigating the effect of BBs or ACEI/ARBs on LVEF in trastuzumab and anthracycline treatments. Meta-analysis was conducted to estimate the mean difference (MD) in LVEF between intervention and placebo groups at follow-up.
The analysis included a total of nine RCTs (n = 1362). All patients were women.
Following were the study's key findings:
- The baseline LVEF means varied between 59.5% and 66.0%. ACEI/ARB therapy irrespective of concomitant anthracycline or trastuzumab therapy was not significantly associated with improved LVEF compared to placebo (MD, 1.5).
- In contrast, BB therapy preserved LVEF significantly better compared with placebo (MD, 2.4).
- Both ACEI/ARBs and BBs were associated with preservation of LVEF compared to placebo in recipients of trastuzumab alone (MD, 2.3), but not anthracycline alone (MD, 1.9).
- Whether LVEF was a primary outcome or not did not influence the MD, nor did the imaging modality.
To conclude, both BB and ACEI/ARB therapies were linked to the preservation of LVEF during trastuzumab and anthracycline-containing regimens as compared with placebo, suggesting both to be beneficial.
Reference:
Christian Lewinter, Torsten Holm Nielsen, Lars Robert Edfors, Cecilia Linde, John Martin Bland, M LeWinter, John G F Cleland, Lars Køber, Frieder Braunschweig, Agneta Mansson-Broberg, A systematic review and meta-analysis of beta-blockers and renin–angiotensin system inhibitors for preventing left ventricular dysfunction due to anthracyclines or trastuzumab in patients with breast cancer, European Heart Journal, 2021;, ehab843, https://doi.org/10.1093/eurheartj/ehab843
MSc. Biotechnology
Medha Baranwal joined Medical Dialogues as an Editor in 2018 for Speciality Medical Dialogues. She covers several medical specialties including Cardiac Sciences, Dentistry, Diabetes and Endo, Diagnostics, ENT, Gastroenterology, Neurosciences, and Radiology. She has completed her Bachelors in Biomedical Sciences from DU and then pursued Masters in Biotechnology from Amity University. She has a working experience of 5 years in the field of medical research writing, scientific writing, content writing, and content management. She can be contacted at  editorial@medicaldialogues.in. Contact no. 011-43720751
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751