Enalapril and Carvedilol for Preventing Chemotherapy-Induced Left Ventricular Systolic Dysfunction in Patients With Malignant Hemopathies

Abstract

Combined treatment with enalapril and carvedilol may prevent LVSD in patients with malignant hemopathies treated with intensive chemotherapy. The clinical relevance of this strategy should be confirmed in larger studies. (Prevention of Left Ventricular Dysfunction During Chemotherapy [OVERCOME]; NCT01110824).

Myocardial Protection During Cardiotoxic Chemotherapy

“…Patients in the intervention group had a lower incidence of the combined event of death or HF (6.7% versus 22%) and of death, HF, or a final LVEF<45% (6.7% versus 24.4%). 75 A recent study also found protective effects on LVEF decline with the use of a combination of candesartan and carvedilol. 76 Finally, a study has recently reported the preventive effects of spironolactone on anthracycline-induced myocardial toxicity in patients with breast cancer.…”

“…In a recent study, the administration of enalapril and carvedilol in patients with hematological malignancies 75 prevented LVEF decline at 6 months, especially in patients with acute leukemia, a group of patients who received more intensive chemotherapy with repeated doses of anthracyclines. Patients in the intervention group had a lower incidence of the combined event of death or HF (6.7% versus 22%) and of death, HF, or a final LVEF<45% (6.7% versus 24.4%).…”

Cardiotoxicity From Human Epidermal Growth Factor Receptor‐2 (HER2) Targeted Therapies

“…Observational studies and small randomized clinical trials suggest a benefit in early initiation of angiotensin‐converting enzyme inhibitors and beta‐blockers for the prevention of cardiotoxicity 15, 89, 90, 91, 92, 93. The PRADA (Prevention of Cardiac Dysfunction During Adjuvant Breast Cancer Therapy) trial tested whether angiotensin receptor blockers and/or beta‐blockers would be effective in preventing cardiotoxicity in patients diagnosed with breast cancer receiving anthracycline‐based chemotherapy with and without trastuzumab.…”

Modern View on Cardiotoxicity of Chemotherapeutics in Oncology Including Anthracyclines

“…Не было получено статистически значимых различий в таких показателях, как общая смертность (Р=0,11), количество больных со сниже-нием ФИ >10% (Р=0,90), ХСН или снижение ФИ >10% (Р=0,22), количество тяжелых нежелательных явлений (Р=0,15). Авторы приходят к выводу, что профилактическое назначение эналаприла вместе с карведилолом перед и во время полихимиотерапии предотвращает левожелудочковую дисфункцию [26].…”