Macedo Ariane V S, Hajjar Ludhmila A, Lyon Alexander R, Nascimento Bruno R, Putzu Alessandro, Rossi Lorenzo, Costa Rafael B, Landoni Giovanni, Nogueira-Rodrigues Angélica, Ribeiro Antonio L P
Department of Cardiology of Hospital das Clínicas, Federal University of Minas Gerais and Department of Internal Medicine, School of Medicine of Federal University of Minas Gerais, Belo Horizonte, Brazil.
Oncoclínicas Group, Belo Horizonte, Brazil.
JACC CardioOncol. 2019 Sep 24;1(1):68-79. doi: 10.1016/j.jaccao.2019.08.003. eCollection 2019 Sep.
The authors performed a systematic review and meta-analysis of randomized and nonrandomized trials on the efficacy of dexrazoxane in patients with breast cancer who were treated with anthracyclines with or without trastuzumab.
Breast cancer treatment with anthracyclines and trastuzumab is associated with an increased risk of cardiotoxicity. Among the various strategies to reduce the risk of cardiotoxicity, dexrazoxane is an option for primary prevention, but it is seldom used in clinical practice.
Online databases were searched from January 1990 up to March 1, 2019, for clinical trials on the use of dexrazoxane for the prevention of cardiotoxicity in patients with breast cancer receiving anthracyclines with or without trastuzumab. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model meta-analysis.
Seven randomized trials and 2 retrospective trials with a total of 2,177 patients were included. Dexrazoxane reduced the risk of clinical heart failure (RR: 0.19; 95% CI: 0.09 to 0.40; p < 0.001) and cardiac events (RR: 0.36; 95% CI: 0.27 to 0.49; p < 0.001) irrespective of previous exposure to anthracyclines. The rate of a partial or complete oncological response, overall survival, and progression-free survival were not affected by dexrazoxane.
Dexrazoxane reduced the risk of clinical heart failure and cardiac events in patients with breast cancer undergoing anthracycline chemotherapy with or without trastuzumab and did not significantly impact cancer outcomes. However, the quality of available evidence is low, and further randomized trials are warranted before the systematic implementation of this therapy in clinical practice.
作者对接受蒽环类药物治疗（无论是否联合曲妥珠单抗）的乳腺癌患者使用右丙亚胺疗效的随机和非随机试验进行了系统评价和荟萃分析。
蒽环类药物和曲妥珠单抗治疗乳腺癌会增加心脏毒性风险。在降低心脏毒性风险的各种策略中，右丙亚胺是一级预防的一种选择，但在临床实践中很少使用。
检索1990年1月至2019年3月1日的在线数据库，查找关于右丙亚胺用于预防接受蒽环类药物治疗（无论是否联合曲妥珠单抗）的乳腺癌患者心脏毒性的临床试验。采用随机效应模型荟萃分析计算风险比（RR）及95%置信区间（CI）。
纳入7项随机试验和2项回顾性试验，共2177例患者。无论之前是否接触过蒽环类药物，右丙亚胺均可降低临床心力衰竭风险（RR：0.19；95%CI：0.09至0.40；p<0.001）和心脏事件风险（RR：0.36；95%CI：0.27至0.49；p<0.001）。右丙亚胺不影响部分或完全肿瘤缓解率、总生存期和无进展生存期。
右丙亚胺降低了接受蒽环类化疗（无论是否联合曲妥珠单抗）的乳腺癌患者临床心力衰竭和心脏事件的风险，且未对癌症结局产生显著影响。然而，现有证据质量较低，在临床实践中系统应用该疗法之前，有必要进行进一步的随机试验。
