NEUROHORMONAL MODULATION FOR THE PREVENTION OF ANTHRACYCLINE-INDUCED CARDIAC DYSFUNCTION IN PATIENTS WITH BREAST CANCER: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMISED CONTROLLED TRIALS
Abstract
Anthracycline-induced cardiac dysfunction (AICD) is cardiac injury associated with potentially cardiotoxic anthracycline therapy, and remains a significant complication for breast cancer patients. Neurohormonal modulation, a therapeutic strategy used primarily in heart failure, including renin–angiotensin system inhibitors and beta-blockers, has been proposed to prevent AICD. Several trials have reported potential cardioprotective benefits, but effectiveness remains uncertain. Therefore, we aimed to evaluate the effect of neurohormonal modulation on AICD incidence and left ventricular ejection fraction (LVEF) in patients receiving anthracycline. A comprehensive literature search was conducted to identify randomised controlled trials (RCTs) investigating the cardioprotective effect of neurohormonal modulation therapy in patients administered with anthracyclines. The primary outcome was AICD incidence, and the secondary outcome was change in LVEF from baseline to the end of study. The meta-analysis was conducted using RevMan with a random-effects model. Fourteen RCTs involving 1,821 patients were included. Neurohormonal modulation was associated with significant reduction in the incidence of AICD (risk ratio [RR] 0.45, 95% confidence interval [CI] 0.31–0.67; p<0.0001; I²=60%). Subgroup analyses demonstrated consistent benefit with renin–angiotensin system inhibitors (RR 0.39, 95% CI 0.22–0.69) and beta-blockers (RR 0.53, 95% CI: 0.28–0.99). Neurohormonal modulation therapy also demonstrated preservation of LVEF (mean difference [MD] 2.09%, 95% CI 1.44–2.74; p<0.00001; I²=87%). Neurohormonal modulation significantly reduces the incidence of AICD and preserves LVEF in breast cancer patients receiving anthracycline-based chemotherapy, supporting its role as a cardioprotective strategy.Figure 1.Forest plots of neurohormonal modulation on (A) incidence of anthracycline-induced cardiac dysfunction and (B) change in left ventricular ejection fraction