Interventions for prevention and treatment of trastuzumab-induced cardiotoxicity: an umbrella review of systematic reviews and meta-analyses

作者：Yunfang Wang, Jianguo Xu, Yafei Xie, Dan Zhou, Mingyue Guo, Qin Yu, Yi Kang, Jin Hui Tian, Tao You · 发表于：Frontiers in Pharmacology · 年份：2024 · DOI：10.3389/fphar.2024.1479983 · 被引用次数：13 · 研究领域：Chemotherapy-induced cardiotoxicity and mitigation、HER2/EGFR in Cancer Research、Advanced Breast Cancer Therapies

Background: Trastuzumab therapy for HER2-positive cancers is associated with cardiotoxicity. This umbrella review synthesizes evidence from systematic reviews and meta-analyses on cardioprotective interventions during trastuzumab treatment. Methods: A comprehensive search was conducted in PubMed, Embase, Cochrane Library, and Web of Science. Systematic reviews and meta-analyses examining cardioprotective interventions in patients receiving trastuzumab were included. The methodological quality was assessed using the AMSTAR-2 tool. Data on cardiac events, treatment interruptions, left ventricular ejection fraction (LVEF) changes, and exercise interventions were synthesized. Results: Ten systematic reviews met the inclusion criteria. Statins demonstrated the strongest cardioprotective effect (RR = 0.47, 95% CI: 0.26-0.84), potentially preventing more than half of cardiac events during trastuzumab therapy, followed by beta-blockers (RR = 0.61, 95% CI: 0.39-0.93). Beta-blockers and ACEIs effectively reduced treatment interruptions, enabling approximately 40% more patients to maintain treatment continuity (RR = 0.63, 95% CI: 0.47-0.86). Among non-pharmacological interventions, structured exercise programs showed significant benefits in preserving cardiac function, demonstrating meaningful improvements in resting LVEF (WMD = -3.27%, 95% CI: -5.86 to -0.68). Discussion: This review demonstrates that cardioprotective interventions, particularly statins and beta-blockers, significantly...