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Review
. 2024 Jun 13;21(2):564-576.
doi: 10.5114/aoms/189501. eCollection 2025.

Efficacy and harms associated with β-blockers for cardiotoxicity in cancer patients undergoing chemotherapy: a systematic review and meta-analysis

Jessica T Li  1 , Amanda M Duddy  1 , Michelle Cardona  1 , Vinay Pasupuleti  2 , Adrian V Hernandez  1   3
Affiliations
Review

Efficacy and harms associated with β-blockers for cardiotoxicity in cancer patients undergoing chemotherapy: a systematic review and meta-analysis

Jessica T Li et al. Arch Med Sci. .

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, I 2 = 0%, very low QoE), LVEF (MD = 2.73%, 95% CI: -0.45% to 5.92%, 12 RCTs, I 2 = 93%, very low QoE), and heart rate (MD = -9.14 bpm, 95% CI: -15.02 to -3.26, two RCTs, I 2 = 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, I 2 = 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.

Keywords: anthracycline; cancer; cardiotoxicity; meta-analysis; β-blockers.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA 2020 flowchart
Figure 2
Figure 2
All-cause mortality
Figure 3
Figure 3
LVEF
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