Protective effect of carvedilol against anthracycline-induced cardiomyopathy on patients with breast cancer and lymphoma

Abstract

Background:Anthracycline antibiotics are potent antineoplastic agents. Unfortunately, despite its broad effectiveness, anthracycline therapy is associated with irreversible dilated cardiomyopathy. Toxic effect may occur at any stage of anthracycline treatment. When it takes place, medical therapy is mostly insufficient. Therefore, prevention of cardiomyopathy has great clinical importance. This study aimed at evaluating the protective effect of carvedilol against anthracycline-induced cardiomyopathy on patients with breast cancer and lymphoma.Methods: In a randomized clinical trial, 66 patients with breast cancer or lymphoma selected for chemotherapy in Tabriz city hospital. These patients randomized in three groups; the first group (control) received placebo; the second group (A) received carvedilol 6.25mg/d and the third group (B) received carvedilol 12.5mg/d for 4months. Conventional echocardiography and tissue Doppler study were employed for evaluating the patients on the baseline and at the end of survey.Results:At the end of 4 months of follow-up, 1 (4.5%) patient in group B, 2 (9.1%) patients in group A and 4 (18.2%) patients of the control group had died. Clinical systolic dysfunction was encountered in 5 (27.8%), 5 (25%) and 1 (4.8%) patients in the control, A and B groups, respectively. A distinctive clinical diastolic dysfunction was encountered in 5 (27.8%), 3 (15%) and 3 (14.3%) patients in the control, A and B groups, respectively. Carvedilol with a dose of 6.25mg/d prohibited the diastolic dysfunction at the end of study without a significant effect on the prevention of diastolic dysfunction. Carvedilol with a dose of 12.5mg/d effectively prevented both the systolic and diastolic dysfunctions at the end of study.Conclusions:The current study showed that prophylactic administration of carvedilol with a dose of 12.5 mg/d might significantly prevent the systolic and diastolic dysfunction of the left ventricle in patients receiving chemotherapy with anthracycline.

Protective Role of Enalapril in Anthracycline-Induced Cardiotoxicity: A Systematic Review

“…Angiotensin-converting enzyme inhibitors (ACEIs) (Cardinale et al, 2006;Zamani et al, 2018) are considered promising cardioprotective agents that can be used for cardiac protection during chemotherapy. The mechanism of cardiac protection is mainly related to the SDF-1a/CXCR4 axis (Wen et al, 2012), hypoxia-inducible factor-1a (HIF-1a) upregulation (Luft, 2017;Zhang and Lin, 2010), nuclear factor kappa-lightchain-enhancer of activated B cells axis (Puddighinu et al, 2018) and a decrease in ROS (Heusch, 2012).…”

<p>Is it possible to prevent chemotherapy-induced heart failure with cardiovascular drugs - the review of the current clinical evidence</p>

“…They observed that a lower dose of carvedilol (6,25 mg/day) did not have a significant effect on the prevention of diastolic and systolic dysfunction, contrary to the dose 12.5 mg/day. These results suggested that the cardioprotective effect was dose-dependent 18…”

The effect of prophylactic carvedilol on subclinical left ventricular dysfunction after 1 cycle FAC chemotherapy in breast cancer patients

“…The study had found significantly lower decrease (p = 0.001) of left ventricular ejection fraction after 6 months post-chemotherapy according to the assessment using echocardiography [24] . Zamani et al had found that administration of carvedilol with dose of 1 × 1.25 mg daily had successfully prevented decline of systolic and diastolic function after receiving anthracycline-containing chemotherapy regimen in 14.7% and 27.8% patients respectively [25] . Abousa et al had reported significant effects on decrease left ventricular ejection fraction after 6 months receiving anthracycline-containing chemotherapy, with scores of 62.0 ± 4.6% to 58.2 ± 6.6% (p = 0.002) [26] .…”