Please use this identifier to cite or link to this item: https://observatorio.fm.usp.br/handle/OPI/26882
Title: Carvedilol for Prevention of Chemotherapy-Related Cardiotoxicity
Authors: AVILA, Monica SamuelAYUB-FERREIRA, Silvia MoreiraWANDERLEY JR., Mauro Rogerio de BarrosCRUZ, Fatima das DoresBRANDAO, Sara Michelly GoncalvesRIGAUD, Vagner Oliveira CarvalhoHIGUCHI-DOS-SANTOS, Marilia HarumiHAJJAR, Ludhmila AbrahaoKALIL FILHO, RobertoHOFF, Paulo MarceloSAHADE, MarinaFERRARI, Marcela S. M.COSTA, Romulo Leopoldo de PaulaMANO, Max SennaCRUZ, Cecilia Beatriz Bittencourt VianaABDUCH, Maria CristinaALVES, Marco Stephan LofranoGUIMARAES, Guilherme VeigaISSA, Victor SarliBITTENCOURT, Marcio SommerBOCCHI, Edimar Alcides
Citation: JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, v.71, n.20, p.2281-2290, 2018
Abstract: 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.
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