Lee, A.R.Y.B.; Yau, C.E.; Low, C.E.; Li, J.; Tyebally, S.M.; Lin, W.; Tan, L.-L.; Liao, C.-T.; Chang, W.-T.; Lee, M.X.; Koo, C.-Y.; Sia, C.-H. Natural Progression of Left Ventricular Function following Anthracyclines without Cardioprotective Therapy: A Systematic Review and Meta-Analysis. Cancers2023, 15, 512.
Lee, A.R.Y.B.; Yau, C.E.; Low, C.E.; Li, J.; Tyebally, S.M.; Lin, W.; Tan, L.-L.; Liao, C.-T.; Chang, W.-T.; Lee, M.X.; Koo, C.-Y.; Sia, C.-H. Natural Progression of Left Ventricular Function following Anthracyclines without Cardioprotective Therapy: A Systematic Review and Meta-Analysis. Cancers 2023, 15, 512.
Lee, A.R.Y.B.; Yau, C.E.; Low, C.E.; Li, J.; Tyebally, S.M.; Lin, W.; Tan, L.-L.; Liao, C.-T.; Chang, W.-T.; Lee, M.X.; Koo, C.-Y.; Sia, C.-H. Natural Progression of Left Ventricular Function following Anthracyclines without Cardioprotective Therapy: A Systematic Review and Meta-Analysis. Cancers2023, 15, 512.
Lee, A.R.Y.B.; Yau, C.E.; Low, C.E.; Li, J.; Tyebally, S.M.; Lin, W.; Tan, L.-L.; Liao, C.-T.; Chang, W.-T.; Lee, M.X.; Koo, C.-Y.; Sia, C.-H. Natural Progression of Left Ventricular Function following Anthracyclines without Cardioprotective Therapy: A Systematic Review and Meta-Analysis. Cancers 2023, 15, 512.
Abstract
Background: Anthracyclines form the backbone of many systemic chemotherapy regimens but dose-limiting cardiotoxicity can also lead to reduction in cardiac function and an increased risk of heart failure. Methods: This review was conducted in accordance with PRISMA guidelines and registered on PROSPERO (CRD42022373496). Results: 26 studies met the eligibility criteria including a total of 910 patients. Overall reduction in pooled mean left ventricular ejection fraction (LVEF) post‐anthracyclines in the placebo arms of included randomised-controlled trials was 4.6% (95% CI, 2.7 to 6.6). The trend in LVEF showed a progressive decline until approximately 180 days after which there was no significant change. Those receiving a cumulative anthracycline dose 300 mg/m2 experienced a more profound reduction. The risk of a 10% absolute decline in LVEF from baseline or decline to an LVEF below 50%, the overall pooled risk was 16% (95% CI: 11 to 21; I2 = 77%). Sensitivity analyses by baseline LVEF and trastuzumab treatment status did not yield significant differences. Conclusion: While the mean LVEF decline in patients without cardioprotective therapy was clinically small, a vulnerable subset experienced significant impairment. Further research to best identify those who benefit most from cardioprotective therapies when receiving anthracyclines are required.
Keywords
Anthracyclines; Cardiotoxicity; Heart failure; Chemotherapy toxicity; Cardio-Oncology; Breast cancer; Haematological cancer
Subject
Medicine and Pharmacology, Oncology and Oncogenics
Copyright:
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.