Heart Failure Therapies for the Prevention of HER2-Monoclonal Antibody-Mediated Cardiotoxicity: A Systematic Review and Meta-Analysis of Randomized Trials

Monoclonal antibodies including trastuzumab, pertuzumab, and antibody-drug conjugates, form the backbone of HER2-positive breast cancer therapy. Unfortunately, an important adverse effect of these agents is cardiotoxicity, occurring in approximately 10% of patients. There is increasing published dat...

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Autores principales:	Lauren J. Brown, Thomas Meredith, Jie Yu, Anushka Patel, Bruce Neal, Clare Arnott, Elgene Lim
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	heart failure prevention breast cancer HER2 therapy Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/f596aab5e9404ec19dbe2756cbfd6c7f
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spelling	oai:doaj.org-article:f596aab5e9404ec19dbe2756cbfd6c7f2021-11-11T15:33:54ZHeart Failure Therapies for the Prevention of HER2-Monoclonal Antibody-Mediated Cardiotoxicity: A Systematic Review and Meta-Analysis of Randomized Trials10.3390/cancers132155272072-6694https://doaj.org/article/f596aab5e9404ec19dbe2756cbfd6c7f2021-11-01T00:00:00Zhttps://www.mdpi.com/2072-6694/13/21/5527https://doaj.org/toc/2072-6694Monoclonal antibodies including trastuzumab, pertuzumab, and antibody-drug conjugates, form the backbone of HER2-positive breast cancer therapy. Unfortunately, an important adverse effect of these agents is cardiotoxicity, occurring in approximately 10% of patients. There is increasing published data regarding prevention strategies for cardiotoxicity, though seldom used in clinical practice. We performed a systematic review and meta-analysis of randomized-controlled trials to evaluate pharmacotherapy for the prevention of monoclonal HER2-directed antibody-induced cardiotoxicity in patients with breast cancer. Online databases were queried from their inception until October 2021. Effects were determined by calculating risk ratios (RRs) and 95% confidence intervals (CI) or mean differences (MD) using random-effects models. We identified five eligible trials. In the three trials (<i>n</i> = 952) reporting data on the primary outcome of cardiotoxicity, there was no clear effect for patients assigned active treatment compared to control (RR = 0.90, 95% CI 0.63 to 1.29, <i>p</i> = 0.57). Effects were similar for ACE-I/ARB and beta-blockers (<i>p</i> homogeneity = 0.50). Active treatment reduced the risk of HER2 therapy interruptions (RR = 0.57, 95% CI 0.43 to 0.77, <i>p</i> < 0.001) with similar findings for ACE-I/ARB and beta-blockers (<i>p</i> homogeneity = 0.97). Prophylactic treatment with ACE-I/ARB or beta-blocker therapy may be of value for cardio-protection in patients with breast cancer prescribed monoclonal antibodies. Further, adequately powered randomized trials are required to define the role of routine prophylactic treatment in this patient group.Lauren J. BrownThomas MeredithJie YuAnushka PatelBruce NealClare ArnottElgene LimMDPI AGarticleheart failurepreventionbreast cancerHER2 therapyNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENCancers, Vol 13, Iss 5527, p 5527 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	heart failure prevention breast cancer HER2 therapy Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	heart failure prevention breast cancer HER2 therapy Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Lauren J. Brown Thomas Meredith Jie Yu Anushka Patel Bruce Neal Clare Arnott Elgene Lim Heart Failure Therapies for the Prevention of HER2-Monoclonal Antibody-Mediated Cardiotoxicity: A Systematic Review and Meta-Analysis of Randomized Trials
description	Monoclonal antibodies including trastuzumab, pertuzumab, and antibody-drug conjugates, form the backbone of HER2-positive breast cancer therapy. Unfortunately, an important adverse effect of these agents is cardiotoxicity, occurring in approximately 10% of patients. There is increasing published data regarding prevention strategies for cardiotoxicity, though seldom used in clinical practice. We performed a systematic review and meta-analysis of randomized-controlled trials to evaluate pharmacotherapy for the prevention of monoclonal HER2-directed antibody-induced cardiotoxicity in patients with breast cancer. Online databases were queried from their inception until October 2021. Effects were determined by calculating risk ratios (RRs) and 95% confidence intervals (CI) or mean differences (MD) using random-effects models. We identified five eligible trials. In the three trials (<i>n</i> = 952) reporting data on the primary outcome of cardiotoxicity, there was no clear effect for patients assigned active treatment compared to control (RR = 0.90, 95% CI 0.63 to 1.29, <i>p</i> = 0.57). Effects were similar for ACE-I/ARB and beta-blockers (<i>p</i> homogeneity = 0.50). Active treatment reduced the risk of HER2 therapy interruptions (RR = 0.57, 95% CI 0.43 to 0.77, <i>p</i> < 0.001) with similar findings for ACE-I/ARB and beta-blockers (<i>p</i> homogeneity = 0.97). Prophylactic treatment with ACE-I/ARB or beta-blocker therapy may be of value for cardio-protection in patients with breast cancer prescribed monoclonal antibodies. Further, adequately powered randomized trials are required to define the role of routine prophylactic treatment in this patient group.
format	article
author	Lauren J. Brown Thomas Meredith Jie Yu Anushka Patel Bruce Neal Clare Arnott Elgene Lim
author_facet	Lauren J. Brown Thomas Meredith Jie Yu Anushka Patel Bruce Neal Clare Arnott Elgene Lim
author_sort	Lauren J. Brown
title	Heart Failure Therapies for the Prevention of HER2-Monoclonal Antibody-Mediated Cardiotoxicity: A Systematic Review and Meta-Analysis of Randomized Trials
title_short	Heart Failure Therapies for the Prevention of HER2-Monoclonal Antibody-Mediated Cardiotoxicity: A Systematic Review and Meta-Analysis of Randomized Trials
title_full	Heart Failure Therapies for the Prevention of HER2-Monoclonal Antibody-Mediated Cardiotoxicity: A Systematic Review and Meta-Analysis of Randomized Trials
title_fullStr	Heart Failure Therapies for the Prevention of HER2-Monoclonal Antibody-Mediated Cardiotoxicity: A Systematic Review and Meta-Analysis of Randomized Trials
title_full_unstemmed	Heart Failure Therapies for the Prevention of HER2-Monoclonal Antibody-Mediated Cardiotoxicity: A Systematic Review and Meta-Analysis of Randomized Trials
title_sort	heart failure therapies for the prevention of her2-monoclonal antibody-mediated cardiotoxicity: a systematic review and meta-analysis of randomized trials
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/f596aab5e9404ec19dbe2756cbfd6c7f
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Heart Failure Therapies for the Prevention of HER2-Monoclonal Antibody-Mediated Cardiotoxicity: A Systematic Review and Meta-Analysis of Randomized Trials

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