Carvedilol for Prevention of Chemotherapy-Related Cardiotoxicity

Imagem de Miniatura
Arquivos
art_AVILA_Carvedilol_for_Prevention_of_ChemotherapyRelated_Cardiotoxicity_2018.PDF (543.15 KB)
Citações na Scopus
360
Tipo de produção
article
Data de publicação
2018
Editora
ELSEVIER SCIENCE INC
DOI
Indexadores
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Autores
Autor de Grupo de pesquisa
Editores
Coordenadores
Organizadores
Citação
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, v.71, n.20, p.2281-2290, 2018
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
BACKGROUND Anthracycline (ANT) chemotherapy is associated with cardiotoxicity. Prevention with beta-blockers remains controversial. OBJECTIVES This prospective, randomized, double-blind, placebo-controlled study sought to evaluate the role of carvedilol in preventing ANT cardiotoxicity. METHODS The authors randomized 200 patients with HER2-negative breast cancer tumor status and normal left ventricular ejection fraction (LVEF) referred for ANT (240 mg/m(2)) to receive carvedilol or placebo until chemotherapy completion. The primary endpoint was prevention of a >= 10% reduction in LVEF at 6 months. Secondary outcomes were effects of carvedilol on troponin I, B-type natriuretic peptide, and diastolic dysfunction. RESULTS Primary endpoint occurred in 14 patients (14.5%) in the carvedilol group and 13 patients (13.5%) in the placebo group (p = 1.0). No differences in changes of LVEF or B-type natriuretic peptide were noted between groups. A significant difference existed between groups in troponin I levels over time, with lower levels in the carvedilol group (p = 0.003). Additionally, a lower incidence of diastolic dysfunction was noted in the carvedilol group (p = 0.039). A nonsignificant trend toward a less-pronounced increase in LV end-diastolic diameter during the follow-up was noted in the carvedilol group (44.1 +/- 3.64 mm to 45.2 +/- 3.2 mm vs. 44.9 +/- 3.6 mm to 46.4 +/- 4.0 mm; p = 0.057). CONCLUSIONS In this largest clinical trial of beta-blockers for prevention of cardiotoxicity under contemporary ANT dosage, the authors noted a 13.5% to 14.5% incidence of cardiotoxicity. In this scenario, carvedilol had no impact on the incidence of early onset of LVEF reduction. However, the use of carvedilol resulted in a significant reduction in troponin levels and diastolic dysfunction.(Carvedilol Effect in Preventing Chemotherap-Induced Cardiotoxicity [CECCy] NCTO1724450)(C) 2018 by the American College of Cardiology Foundation.
Palavras-chave
beta-blockers, cardiomyopathy, chemotherapy, prevention, troponin
URI
https://observatorio.fm.usp.br/handle/OPI/26882
Referências
  1. Beheshti AT, 2016, CARDIOLOGY, V134, P47, DOI 10.1159/000442722
  2. Bloom MW, 2016, CIRC-HEART FAIL, V9, DOI 10.1161/CIRCHEARTFAILURE.115.002661
  3. Bocchi EA, 2012, ARQ BRAS CARDIOL, V98, P1, DOI 10.1590/S0066-782X2012000700001
  4. Bosch X, 2013, J AM COLL CARDIOL, V61, P2355, DOI 10.1016/j.jacc.2013.02.072
  5. Cardinale D, 2004, CIRCULATION, V109, P2749, DOI 10.1161/01.CIR.0000130926.51766.CC
  6. Cardinale D, 2015, CIRCULATION, V131, P1981, DOI 10.1161/CIRCULATIONAHA.114.013777
  7. Cardinale D, 2010, J CLIN ONCOL, V28, P3910, DOI 10.1200/JCO.2009.27.3615
  8. Cardinale D, 2010, J AM COLL CARDIOL, V55, P213, DOI 10.1016/j.jacc.2009.03.095
  9. Eichhorn E, 2001, NEW ENGL J MED, V344, P1659
  10. Elitok A, 2014, CARDIOL J, V21, P509, DOI 10.5603/CJ.a2013.0150
  11. Ewer MS, 2015, NAT REV CARDIOL, V12, P620, DOI 10.1038/nrcardio.2015.133
  12. Gulati G, 2016, EUR HEART J, V37, P1671, DOI 10.1093/eurheartj/ehw022
  13. Hamo Carine E, 2017, Card Fail Rev, V3, P66, DOI 10.15420/cfr.2016:24:2
  14. Henriksen PA, 2017, HEART
  15. Kalay N, 2006, J AM COLL CARDIOL, V48, P2258, DOI 10.1016/j.jacc.2006.07.052
  16. Kaya MG, 2013, INT J CARDIOL, V167, P2306, DOI 10.1016/j.ijcard.2012.06.023
  17. Khosrow-Khavar F, 2017, ANN ONCOL, V28, P487, DOI 10.1093/annonc/mdw673
  18. Lang RM, 2015, EUR HEART J-CARD IMG, V16, P233, DOI 10.1093/ehjci/jev014
  19. McGowan JV, 2017, CARDIOVASC DRUG THER, V31, P63, DOI 10.1007/s10557-016-6711-0
  20. Miller KD, 2016, CA-CANCER J CLIN, V66, P271, DOI 10.3322/caac.21349
  21. Nabati M, 2017, J CARDIOVASC PHARM, V69, P279, DOI 10.1097/FJC.0000000000000470
  22. Nagueh SF, 2016, EUR HEART J-CARD IMG, V17, P1321, DOI 10.1093/ehjci/jew082
  23. Nagueh SF, 2009, J AM SOC ECHOCARDIOG, V22, P107, DOI 10.1016/j.echo.2008.11.023
  24. National Institutes of Health, 2009, COMM TERM CRIT ADV E
  25. Patnaik JL, 2011, BREAST CANCER RES, V13, DOI 10.1186/bcr2901
  26. Sawaya H, 2012, CIRC-CARDIOVASC IMAG, V5, P596, DOI 10.1161/CIRCIMAGING.112.973321
  27. Seicean S, 2013, CIRC-HEART FAIL, V6, P420, DOI 10.1161/CIRCHEARTFAILURE.112.000055
  28. Suter TM, 2013, EUR HEART J, V34, P1102, DOI 10.1093/eurheartj/ehs181
  29. Thygesen K, 2010, EUR HEART J, V31, P2197, DOI 10.1093/eurheartj/ehq251
  30. Troughton RW, 2005, AM J CARDIOL, V96, P257, DOI 10.1016/j.amjcard.2005.03.055
  31. Valachis A, 2015, BREAST CANCER-TARGET, V7, P21, DOI 10.2147/BCTT.S47227
  32. Vejpongsa P, 2014, J AM COLL CARDIOL, V64, P938, DOI 10.1016/j.jacc.2014.06.1167
  33. YUE TL, 1992, J PHARMACOL EXP THER, V263, P92
  34. Zamorano JL, 2016, EUR HEART J, V37, P2768, DOI 10.1093/eurheartj/ehw211

Coleções
Artigos e Materiais de Revistas Científicas - FM/MCP
Artigos e Materiais de Revistas Científicas - FM/MDR
Artigos e Materiais de Revistas Científicas - HC/ICESP
Artigos e Materiais de Revistas Científicas - HC/InCor
Artigos e Materiais de Revistas Científicas - HU
Artigos e Materiais de Revistas Científicas - LIM/08
Carregar mais