Li Jessica T, Duddy Amanda M, Cardona Michelle, Pasupuleti Vinay, Hernandez Adrian V
University of Connecticut School of Pharmacy, Storrs, United States.
Oxford PharmaGenesis, Inc., Newtown, United States.
Arch Med Sci. 2024 Jun 13;21(2):564-576. doi: 10.5114/aoms/189501. eCollection 2025.
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.
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).
Twelve RCTs were selected ( = 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, = 0%, very low QoE), LVEF (MD = 2.73%, 95% CI: -0.45% to 5.92%, 12 RCTs, = 93%, very low QoE), and heart rate (MD = -9.14 bpm, 95% CI: -15.02 to -3.26, two RCTs, = 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, = 0%, moderate QoE). There were no effects on other outcomes, all with very low QoE.
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.
在乳腺癌和淋巴瘤患者中，蒽环类药物与早期和晚期剂量相关的心脏毒性有关。我们系统地评估了β受体阻滞剂在接受化疗的乳腺癌和淋巴瘤患者中的疗效和危害。
我们检索了五个数据库以及截至2022年10月10日的预印本，以查找评估β受体阻滞剂对乳腺癌和淋巴瘤患者蒽环类药物相关心脏毒性影响的随机对照试验（RCT）。主要结局包括全因死亡率、左心室射血分数（LVEF）、左心室舒张末期和收缩末期直径（LVEDD、LVESD）、E'峰速度、E/A比值、E/e'比值和NT-pro BNP水平。次要结局是心率。进行了逆方差随机效应荟萃分析，并使用GRADE方法评估证据质量（QoE）。
共纳入12项RCT（n = 1,794）。7项RCT评估了卡维地洛。平均年龄为39至52岁；88.5%为女性；79.4%患有乳腺癌，11.5%患有淋巴瘤。关于β受体阻滞剂对全因死亡率（RR = 0.87，95%CI：0.55至1.37，12项RCT，I² = 0%，极低QoE）、LVEF（MD = 2.73%，95%CI：-0.45%至5.92%，12项RCT，I² = 93%，极低QoE）和心率（MD = -9.14次/分钟，95%CI：-15.02至-3.26，2项RCT，I² = 87%，极低QoE）与对照组相比的影响，证据非常不确定。β受体阻滞剂可能略微降低NT-pro BNP水平（MD = -15.35 pg/ml，95%CI：-22.39至-8.31，2项RCT，I² = 0%，中等QoE）。对其他结局无影响，所有结局的QoE均极低。
预防性使用β受体阻滞剂进行心脏保护对接受蒽环类药物治疗的癌症患者的全因死亡率、LVEF或心脏功能结局几乎没有影响。
