PDF(Pubmed)
Abstract：
Anthracyclines and trastuzumab are widely used to treat breast cancer but increase the risk of cardiomyopathy and heart failure. With the use of trastuzumab and anthracycline-containing medications, this study intends to evaluate the effectiveness and security of current treatments against cardiotoxicity. We conducted a systematic review of randomized controlled trials (RCTs), which used at least one angiotensin-converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB), or beta-blocker (BB) to prevent cardiotoxicity of antineoplastic agents for breast cancer, in 4 databases (PubMed, Cochrane Library, EMBASE, Web of Science) from inception to 11 May 2022, without language restrictions. The outcome of interest was left ventricular ejection fraction (LVEF) and adverse events. Stata 15 and R software 4.2.1 were used to perform all statistical analyses. The Cochrane version 2 of the risk of bias tool was used to assess the risk of bias, and the grading of recommendations assessment, development, and evaluation (GRADE) assessment was used to appraise the quality of the evidence. Fifteen randomized clinical studies with a total of 1977 patients were included in the analysis. The included studies demonstrated statistically significant LVEF in the ACEI/ARB and BB treatment groups (χ2 = 184.75, I2 = 88.6%, p = 0.000; SMD 0.556, 95% CI 0.299 to 0.813). In an exploratory subgroup analysis, the benefit of experimental agents on LVEF, whether anthracyclines or trastuzumab, was prominent in patients treated with ACEIs, ARBs, and BBs. Compared to placebo, ACEI/ARB and BB treatments in breast cancer patients protect against cardiotoxicity after trastuzumab and anthracycline-containing medication treatment, indicating a benefit for both.
摘要：
蒽环类和曲妥珠单抗广泛用于治疗乳腺癌，但增加心肌病和心力衰竭的风险。使用曲妥珠单抗和含蒽环类药物，本研究旨在评估当前治疗心脏毒性的有效性和安全性。我们对随机对照试验(RCTs)进行了系统评价，使用至少一种血管紧张素转换酶抑制剂（ACEI），血管紧张素受体阻滞剂（ARB），或β受体阻滞剂（BB），以防止抗肿瘤药物对乳腺癌的心脏毒性，在4个数据库中(PubMed，科克伦图书馆,EMBASE,WebofScience）从成立到2022年5月11日，没有语言限制。感兴趣的结果是左心室射血分数（LVEF）和不良事件。使用Stata15和R软件4.2.1进行所有统计分析。使用偏差风险工具的Cochrane版本2来评估偏差风险，以及建议评估的分级，发展,采用评估法(GRADE)对证据质量进行评价。分析中包括15项随机临床研究，共1977名患者。纳入的研究表明，ACEI/ARB和BB治疗组的LVEF具有统计学意义（χ2=184.75，I2=88.6％，p=0.000；SMD0.556，95%CI0.299至0.813）。在探索性亚组分析中，实验药物对LVEF的好处，无论是蒽环类还是曲妥珠单抗，在接受ACEI治疗的患者中表现突出，ARBs,和BB。与安慰剂相比，乳腺癌患者的ACEI/ARB和BB治疗可预防曲妥珠单抗和蒽环类药物治疗后的心脏毒性，这表明双方都有好处。
