Department of Epidemiology and Biostatistics, Health School, Isfahan University of Medical Sciences, Isfahan, Iran.
Student Research Committee, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
J Oncol Pharm Pract. 2021 Mar;27(2):414-427. doi: 10.1177/1078155220965674. Epub 2020 Oct 21.
Doxorubicin- and epirubicin-induced cardiotoxicities are life threatening for those suffering from breast cancer. Comparing the effects of different strategies on the prevention of these agent-induced cardiotoxicities remains unexplored. A comprehensive review of clinical trials was performed on the prevention of epirubicin- and/or doxorubicin-induced cardiotoxicity in HER2-positive metastatic breast cancer patients. The reduction in ejection fraction was directed at evaluating cardiac toxicity. Fourteen articles evaluated cardiotoxicity as a condition among 2945 individuals, evaluating doxorubicin, epirubicin, Liposomal Doxorubicin (LD), Pegylated Liposomal Doxorubicin (PLD), dexrazoxane plus doxorubicin or epirubicin, and Angiotensin-Converting Enzyme Inhibitors (ACEIs) plus doxorubicin. Pooled Odds Ratio (OR) of 0.043 with a 95% credible interval (CrI) between 0.005 and 0.22 indicated that the dexrazoxane plus epirubicin reduced the number of cardiac events compared with doxorubicin. Furthermore, doxorubicin and epirubicin represented the most effective interventions with a 52% probability of success. Also, the best treatment for reducing Congestive Heart Failure (CHF) was dexrazoxane plus epirubicin with a probability of 43%. For the Left Ventricular Ejection Fraction (LVEF) reduction outcome, ACEIs plus doxorubicin was ranked first with a success probability of 61.2% and they could significantly prevent the reduction in LVEF compared with LD, epirubicin, or doxorubicin.
Our data suggested that angiotensin-converting enzyme inhibitors and dexrazoxane plus epirubicin were the most effective interventions for preventing cardiotoxicity and CHF. However, ACEIs plus doxorubicin was the best treatment for preventing LVEF reduction.
多柔比星和表柔比星引起的心脏毒性对乳腺癌患者的生命构成威胁。比较不同策略对预防这些药物引起的心脏毒性的效果仍然是未知的。对 HER2 阳性转移性乳腺癌患者中预防表柔比星和/或多柔比星引起的心脏毒性的临床试验进行了全面综述。通过评估射血分数降低来评估心脏毒性。有 14 篇文章评估了 2945 例患者的心脏毒性状况，评估了多柔比星、表柔比星、脂质体多柔比星 (LD)、聚乙二醇化脂质体多柔比星 (PLD)、地拉佐辛联合多柔比星或表柔比星以及血管紧张素转化酶抑制剂 (ACEIs) 联合多柔比星。地拉佐辛联合表柔比星组发生心脏事件的比值比（OR）为 0.043，95%可信区间（CrI）在 0.005 和 0.22 之间，表明地拉佐辛联合表柔比星与多柔比星相比减少了心脏事件的发生。此外，多柔比星和表柔比星是最有效的干预措施，成功率为 52%。此外，降低充血性心力衰竭（CHF）的最佳治疗方法是地拉佐辛联合表柔比星，成功率为 43%。对于左心室射血分数（LVEF）降低的结果，ACEIs 联合多柔比星排名第一，成功率为 61.2%，与 LD、表柔比星或多柔比星相比，它们可以显著预防 LVEF 的降低。
我们的数据表明，血管紧张素转换酶抑制剂和地拉佐辛联合表柔比星是预防心脏毒性和 CHF 的最有效干预措施。然而，ACEIs 联合多柔比星是预防 LVEF 降低的最佳治疗方法。
