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Meta-Analysis
. 2023 Nov;28(6):1405-1415.
doi: 10.1007/s10741-023-10328-z. Epub 2023 Jul 7.

ACEI/ARB and beta-blocker therapies for preventing cardiotoxicity of antineoplastic agents in breast cancer: a systematic review and meta-analysis

Yu Gao #  1 , Ruiting Wang #  2 , Jinchi Jiang  2 , Yueyao Hu  2 , Haijing Li  1 , Yong Wang  3   4
Affiliations
Meta-Analysis

ACEI/ARB and beta-blocker therapies for preventing cardiotoxicity of antineoplastic agents in breast cancer: a systematic review and meta-analysis

Yu Gao et al. Heart Fail Rev. 2023 Nov.

Abstract

Anthracyclines and trastuzumab are widely used to treat breast cancer but increase the risk of cardiomyopathy and heart failure. With the use of trastuzumab and anthracycline-containing medications, this study intends to evaluate the effectiveness and security of current treatments against cardiotoxicity. We conducted a systematic review of randomized controlled trials (RCTs), which used at least one angiotensin-converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB), or beta-blocker (BB) to prevent cardiotoxicity of antineoplastic agents for breast cancer, in 4 databases (PubMed, Cochrane Library, EMBASE, Web of Science) from inception to 11 May 2022, without language restrictions. The outcome of interest was left ventricular ejection fraction (LVEF) and adverse events. Stata 15 and R software 4.2.1 were used to perform all statistical analyses. The Cochrane version 2 of the risk of bias tool was used to assess the risk of bias, and the grading of recommendations assessment, development, and evaluation (GRADE) assessment was used to appraise the quality of the evidence. Fifteen randomized clinical studies with a total of 1977 patients were included in the analysis. The included studies demonstrated statistically significant LVEF in the ACEI/ARB and BB treatment groups (χ2 = 184.75, I2 = 88.6%, p = 0.000; SMD 0.556, 95% CI 0.299 to 0.813). In an exploratory subgroup analysis, the benefit of experimental agents on LVEF, whether anthracyclines or trastuzumab, was prominent in patients treated with ACEIs, ARBs, and BBs. Compared to placebo, ACEI/ARB and BB treatments in breast cancer patients protect against cardiotoxicity after trastuzumab and anthracycline-containing medication treatment, indicating a benefit for both.

Keywords: ACEI/ARB; Beta-blocker; Breast cancer; Cardiotoxicity; LVEF.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The PRISMA search strategy flow chart
Fig. 2
Fig. 2
Primary outcome. Meta-analysis of the impact of concomitant treatment with ACEIs, ARBs, and BBs compared with placebo on left ventricular ejection fraction in patients treated with anthracyclines or trastuzumab. SMD, standardized mean difference; CI, confidence interval
Fig. 3
Fig. 3
Meta-analysis of the impact of concomitant treatment with ACEIs or ARBs alone compared with placebo on left ventricular ejection fraction in patients treated with anthracyclines or trastuzumab. SMD, standardized mean difference; CI, confidence interval
Fig. 4
Fig. 4
Meta-analysis of the impact of concomitant treatment with BBs alone compared with placebo on left ventricular ejection fraction in patients treated with anthracyclines or trastuzumab. SMD, standardized mean difference; CI, confidence interval
Fig. 5
Fig. 5
Meta-analysis of the impact of concomitant treatment with ACEIs or ARB combined with BB compared with placebo on left ventricular ejection fraction in patients treated with anthracyclines or trastuzumab. SMD, standardized mean difference; CI, confidence interval
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