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CLINICAL PHARMACOLOGY / SYSTEMATIC REVIEW/META-ANALYSIS
Efficacy and harms associated with β-blockers for cardiotoxicity in cancer patients undergoing chemotherapy: a systematic review and meta-analysis
1
University of Connecticut School of Pharmacy, Storrs, United States
2
Oxford PharmaGenesis, Inc., Newtown, United States
3
Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Peru
Submission date: 2024-02-04
Final revision date: 2024-05-17
Acceptance date: 2024-05-30
Online publication date: 2024-06-13
Corresponding author
Adrian V. Hernandez
University of Connecticut School of Pharmacy Storrs, CT 06269, US Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET) Vicerrectorado de Investigación Universidad San Ignacio de Loyola, Lima 15024, Peru
University of Connecticut School of Pharmacy Storrs, CT 06269, US Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET) Vicerrectorado de Investigación Universidad San Ignacio de Loyola, Lima 15024, Peru
KEYWORDS
TOPICS
ABSTRACT
Introduction:
In patients with breast cancer and lymphoma, anthracyclines are associated with early and late dose-related cardiotoxicity. We systematically evaluated the efficacy and harms of the use of β-blockers in breast cancer and lymphoma patients undergoing chemotherapy.
Material and methods:
We searched five engines, and pre-prints until October 10, 2022, for randomized controlled trials (RCTs) evaluating β-blockers for anthracycline-associated cardiotoxicity in breast cancer and lymphoma patients. Primary outcomes were all-cause mortality, left ventricular ejection fraction (LVEF), left ventricular end-diastolic and end-systolic diameter (LVEDD, LVESD), peak E' velocity, E/A ratio, E/e' ratio, and NT-pro BNP levels. The secondary outcome was heart rate. Inverse variance random effect meta-analyses were performed, and we used GRADE methods to assess quality of evidence (QoE).
Results:
Twelve RCTs were selected (n = 1,794). Seven RCTs evaluated carvedilol. Mean ages were 39 to 52 years; 88.5% were women; 79.4% had breast cancer, and 11.5% lymphoma. The evidence was very uncertain about the effect of β-blockers on all-cause mortality (RR = 0.87, 95% CI: 0.55 to 1.37, 12 RCTs, I2 = 0%, very low QoE), LVEF (MD = 2.73%, 95% CI: –0.45% to 5.92%, 12 RCTs, I2 = 93%, very low QoE), and heart rate (MD = –9.14 bpm, 95% CI: –15.02 to –3.26, two RCTs, I2 = 87%, very low QoE) vs. controls. β-blockers likely reduced NT-pro BNP levels slightly (MD = –15.35 pg/ml, 95% CI: –22.39 to –8.31, two RCTs, I2 = 0%, moderate QoE). There were no effects on other outcomes, all with very low QoE.
Conclusions:
Prophylactic use of β-blockers for cardioprotection had little to no effect on all-cause mortality, LVEF or cardiac function outcomes in cancer patients undergoing anthracycline therapy.
In patients with breast cancer and lymphoma, anthracyclines are associated with early and late dose-related cardiotoxicity. We systematically evaluated the efficacy and harms of the use of β-blockers in breast cancer and lymphoma patients undergoing chemotherapy.
Material and methods:
We searched five engines, and pre-prints until October 10, 2022, for randomized controlled trials (RCTs) evaluating β-blockers for anthracycline-associated cardiotoxicity in breast cancer and lymphoma patients. Primary outcomes were all-cause mortality, left ventricular ejection fraction (LVEF), left ventricular end-diastolic and end-systolic diameter (LVEDD, LVESD), peak E' velocity, E/A ratio, E/e' ratio, and NT-pro BNP levels. The secondary outcome was heart rate. Inverse variance random effect meta-analyses were performed, and we used GRADE methods to assess quality of evidence (QoE).
Results:
Twelve RCTs were selected (n = 1,794). Seven RCTs evaluated carvedilol. Mean ages were 39 to 52 years; 88.5% were women; 79.4% had breast cancer, and 11.5% lymphoma. The evidence was very uncertain about the effect of β-blockers on all-cause mortality (RR = 0.87, 95% CI: 0.55 to 1.37, 12 RCTs, I2 = 0%, very low QoE), LVEF (MD = 2.73%, 95% CI: –0.45% to 5.92%, 12 RCTs, I2 = 93%, very low QoE), and heart rate (MD = –9.14 bpm, 95% CI: –15.02 to –3.26, two RCTs, I2 = 87%, very low QoE) vs. controls. β-blockers likely reduced NT-pro BNP levels slightly (MD = –15.35 pg/ml, 95% CI: –22.39 to –8.31, two RCTs, I2 = 0%, moderate QoE). There were no effects on other outcomes, all with very low QoE.
Conclusions:
Prophylactic use of β-blockers for cardioprotection had little to no effect on all-cause mortality, LVEF or cardiac function outcomes in cancer patients undergoing anthracycline therapy.
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