Evaluating cardioprotective strategies for anthracycline-induced cardiotoxicity in breast cancer: insights from a systematic review and network meta-analysis.

Introduction: Anthracycline-induced cardiotoxicity is a significant concern for breast cancer patients undergoing treatment, often leading to chronic cardiovascular complications and reduced long-term survival. The study aimed to systematically evaluate the efficacy of nine classes of pharmacological agents in protecting against cardiotoxicity in breast cancer patients treated with anthracyclines.

Methods: A comprehensive search of databases was performed from January 2000 to October 2024 to identify randomized controlled trials (RCTs) investigating cardioprotective agents. The risk of bias in the studies was evaluated using the Cochrane risk-of-bias tool. Bayesian network meta-analysis was conducted in Stata 15.1.

Results: Of 3718 studies identified, 29 RCTs involving 2599 patients were included in the network systematic review. The study found that trimetazidine significantly improved left ventricular ejection fraction (LVEF), with a Surface Under the Cumulative Ranking (SUCRA) of 94.0%. The combination of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker with beta-blocker (AA-BB) significantly improved global longitudinal strain (GLS), with a SUCRA of 72.8%. Dexrazoxane was highly effective, significantly reducing B-type natriuretic peptide (BNP) levels, cardiac troponin (cTn) levels, and the E/e' ratio (ratio of the mitral early filling velocity to the mean early relaxation tissue velocity), with SUCRA values of 98.9%, 98.2%, and 99.9%, respectively. Additionally, mineralocorticoid receptor antagonist (MRA) showed the highest SUCRA of 88.4% for improving the E/A ratio (ratio of the mitral early diastolic velocity to the late diastolic velocity).

Discussion: Trimetazidine, ACEI/ARB, beta-blocker, dexrazoxane, and MRA demonstrate potential as cardioprotective agents in breast cancer patients undergoing anthracycline chemotherapy. Further research is needed to elucidate the specific cardioprotective mechanisms against anthracycline-induced cardiotoxicity.