Vacharanukrauh Pinyadapat, Miller Kyle J, Alif Sheikh M, Grace Fergal, Rahman Muhammad Aziz
Institute of Health and Wellbeing, Federation University Australia, Ballarat, VIC, Australia.
School of Psychological Sciences, Monash University, Melbourne, VIC, Australia.
Breast Cancer Res Treat. 2025 Nov;214(1):1-23. doi: 10.1007/s10549-025-07791-7. Epub 2025 Aug 5.
This study aimed to systematically assess the efficacy of cardioprotective agents in preventing anthracycline-induced cardiotoxicity in patients with breast cancer using a comprehensive network meta-analysis (NMA).
This study included patients with breast cancer undergoing anthracycline-based chemotherapy. Randomized controlled trials (RCTs) published before March 2020 were identified through systematic searches in MEDLINE, Cochrane CENTRAL, Web of Science, and CINAHL. The primary outcome was left ventricular ejection fraction (LVEF), assessed using cardiac magnetic resonance imaging, multigated radionuclide angiography, or echocardiography. The NMA integrated direct and indirect comparisons to estimate the relative effectiveness of pharmacological interventions.
The systematic review included 31 RCTs with 3,228 participants, whereas the NMA synthesized 25 effect sizes from 15 RCTs. Mineralocorticoid receptor antagonists (MRAs) [standardized mean difference (SMD): -1.78, 95% confidence interval (CI): -2.81 to -0.75] and trimetazidine (SMD: -1.12, 95%CI: -2.32 to -0.09) exhibited the most substantial cardioprotective effects. Dexrazoxane (SMD: -0.53, 95%CI: -1.90 to -0.02) and β-blockers (SMD: -0.34, 95%CI: -0.70 to 0.02) showed potential benefits, albeit with greater uncertainty. Direct comparisons showed that dexrazoxane was more effective than β-blockers (SMD: -1.25, 95%CI: -2.22 to -0.48), with mineralocorticoid receptor antagonists (MRAs) outperforming both. Despite heterogeneity and potential publication bias, mineralocorticoid receptor antagonists (MRAs) and trimetazidine consistently ranked as the most effective interventions. LVEF findings confirmed the cardioprotective benefits of β-blockers, ARBs, ACE inhibitors, and dexrazoxane.
RCT evidence suggested that cardioprotective drugs effectively mitigate anthracycline-induced LVEF decline. However, the lack of direct head-to-head trials limits definitive conclusions on comparative efficacy, warranting trials in patients with lower baseline LVEF to optimize cardioprotective strategies.
本研究旨在通过全面的网络荟萃分析（NMA）系统评估心脏保护剂在预防乳腺癌患者蒽环类药物所致心脏毒性方面的疗效。
本研究纳入接受蒽环类药物化疗的乳腺癌患者。通过在MEDLINE、Cochrane CENTRAL、科学网和CINAHL中进行系统检索，确定2020年3月之前发表的随机对照试验（RCT）。主要结局为左心室射血分数（LVEF），采用心脏磁共振成像、多门控放射性核素血管造影或超声心动图进行评估。NMA整合直接和间接比较，以估计药物干预的相对有效性。
系统评价纳入31项RCT，共3228名参与者，而NMA综合了15项RCT的25个效应量。盐皮质激素受体拮抗剂（MRAs）[标准化均数差（SMD）：-1.78，95%置信区间（CI）：-2.81至-0.75]和曲美他嗪（SMD：-1.12，95%CI：-2.32至-0.09）表现出最显著的心脏保护作用。右丙亚胺（SMD：-0.53，95%CI：-1.90至-0.02）和β受体阻滞剂（SMD：-0.34，95%CI：-0.70至0.02）显示出潜在益处，尽管不确定性更大。直接比较显示，右丙亚胺比β受体阻滞剂更有效（SMD：-1.25，95%CI：-2.22至-0.48），盐皮质激素受体拮抗剂（MRAs）的效果优于两者。尽管存在异质性和潜在的发表偏倚，但盐皮质激素受体拮抗剂（MRAs）和曲美他嗪始终被列为最有效的干预措施。LVEF的研究结果证实了β受体阻滞剂、ARB、ACE抑制剂和右丙亚胺的心脏保护益处。
RCT证据表明，心脏保护药物可有效减轻蒽环类药物所致的LVEF下降。然而，缺乏直接的头对头试验限制了关于比较疗效的确定性结论，需要在基线LVEF较低的患者中进行试验，以优化心脏保护策略。
