From: Strategies to prevent anthracycline-induced cardiotoxicity in cancer survivors
Reference | Medications | Patients (groups), Na | Follow-Up, mean (SD) Months | Imaging Modality | Results by group |
---|---|---|---|---|---|
Avila et al. [86] | Carvedilol (3.125 mg BID increasing every 3 weeks to max 25 mg BID) vs. placebo | 192 (96/96) | 6 | Echo | Carvedilol LVEF 65.2% → 63.9% Placebo LVEF 64.8% → 63.9% P = 0.84 -Lower troponin I levels in the carvedilol group (P = 0.003) -Lower incidence of diastolic dysfunction in the carvedilol group (P = 0.04) |
Kalay et al. [87] | Carvedilol (12.5 mg) daily vs. placebo | 50 (25/25) | 5.2 (1.2) | Echo | Carvedilol: LVEF 70.5% → 69.7% Placebo: LVEF 68.9% → 52.3%†RR: 0.2 (0.03–1.59) |
Tashakori et al. [88] | Carvedilolb vs. control | 70 (30/40) | 1 week | Strain by Speckle Tracking Echo | No significant reduction in strain and strain-rate parameters after intervention, compared to control group (P < 0.001) |
Elitok et al. [89] | Carvedilolc vs. control | 80 (40/40) | 6 | Echo | - Mean LVEF, LVFS, and LV dimensions similar before and after cancer therapy - Significantly worse LV basal septal (0.7 vs. 0.94) and lateral peak systolic strain (0.72 vs. 1.08) in control group after treatment while these measures did not differ between treatment groups at baseline. - No clinical cardiotoxic events in either group |
Nabati et al. [96] | Carvedilol | 91 (45/46) | 6 | Echo | - Carvedilol: No change in mean LVEF - Control: Mean drop of 10% LVEF Placebo group had a higher frequency of TnI concentrations > 0.05 at 30 days (48.6% vs. 24.4%, P = 0.03) |
Jhorawat et al. [90] | Carvedilolc vs. control | 54 (27/27) | 6 | Echo | Carvedilol: LVEF 63.19% ➔ 63.88% LVFS 34% ➔ 34.6% Control: LVEF 67.27% ➔ 60.82%†LVFS 38.48% ➔ 34.6†LV end-systolic diameter Control mean (SD): 28.26 (5.50 mm➔ 31.25 (6.50) mm†) Carvedilol: unchanged |
Kaya et al. [91] | Nebivolol (5 mg) daily vs. placebo f | 45 (27/18) | 6 | Echo | Nebivolol: LVEF 65.6% → 63.8% Placebo: LVEF 66.6% → 57.5%†(P = 0.01) |
Cardinale et al. [93] | Enalapril at start of chemotherapy (prevention arm) vs. troponin triggered enalapril therapy | 273 (136/137) | 12 | Echo | Troponin elevation incidence: Prevention group: 23% vs. Troponin triggered group 26% (P = 0.50) Cardiotoxicity incidence: 2 in prevention group vs. 1 in troponin-triggered group |
Janbabai et al. [94] | Enalapril (17.94 [4.10] mg) vs. control | 69 (34/35) | 6 | Echo | Δ mean LVEF from baseline at 6 months: 0.55 vs. -13.3, P < 0.001 In the enalapril group, tissue Doppler, E/e’ ratio, mean LVEF and cTnI and CK-MB levels were significantly unchanged compared to the controls. |
Nakamae et al. [95] | Valsartan (80 mg) | 40 (20/20) | 7 days | Echo | Valsartan significantly inhibited the dilatation of LVDd (P = 0.01), elevation of BNP (P = 0.001), and prolongation of the QTc interval and QTc dispersion (P < 0.001 and P = 0.02, respectively) |
Georgakopoulos et al. [97] | Metoprolol d vs. enalapril d vs. placeboe | 125 (42/43/40) | 31 (Longest 36) | Clinical | Cardiotoxicity incidence: Metoprolol: 1 vs. 3, not significant Enalapril: 2 vs. 3, not significant No difference in echocardiographic variables among 3 groups at 12 months Comments: -Results published as a letter not full article -Appears to be a cohort study, not a randomized trial -Cardiotoxicity not defined |
Bosch et al. [11] | Enalapril (8.6 [5.9] mg) + Carvedilol (23.8 [17] mg) vs. no treatment f | 90 (45/45) | 6 | Echo and CMR | Enalapril + carvedilol: LVEF 63.3% → 62.9% Control: LVEF 64.6% → 57.9%†cTnI concentrations did not differ between 2 groups (P = 0.59) |
Gulati et al. [12] | Candesartan (32 mg) g + metoprolol (100 mg) vs. Candesartan + placebo vs. Metoprolol g + placebo vs. Placebo + placebo | 126 (30/32/32/ 32) | 10–61 weeks | CMR | Δ LVEF from baseline 1. Candesartan: − 0.8 vs. -2.6%, P = 0.023 2. Metoprolol: − 1.6 vs. -1.8%, P = 0.77 Data were analyzed differently (comparing all those who received a drug to those who did not) from factorial design of the trial. |
Akpek et al. [104] | Spironolactone h vs. placebo | 83 (43/40) | 24.0 [2.9] weeks | Echo | Spironolactone LVEF 67% → 65.7% (P = 0.094) Placebo LVEF 67.7% → 53.6% (P < 0.001) Troponin and NT-proBNP remained in normal limits. Increase in the control group was more than in the spironolactone group |
Gupta et al. (PEDIATRIC) [105] | Enalaprili vs. placebo | 84 (44/40) | 6 | Echo | Enalapril LVEF 65.73% → 62.25% Placebo LVEF 64.85% → 56.15%†> 20% decrease in LVEF: Enalapril - 0 Placebo- 3 patients (8%) Higher proBNP in placebo group (P < 0.001) Higher cTnI level in placebo group (P = 0.035) |
El-Shitany et al. (PEDIATRIC) [106] | Carvedilol j vs. control | 50 (25/25) | After last doxorubicin dose | Echo | -FS (2D) and GPSS (2DS) significantly increased in carvedilol treated group. -Carvedilol pretreatment inhibited ADR-induced increase in plasma troponin I and LDH. (Post treatment troponin, 0.061 vs. 0.023, P ≤ 0.05. Post treatment, LDH 957 vs. 410, P ≤ 0.05) |