Cardioprotection against cardiac dysfunction from breast cancer chemotherapy: a bayesian and frequentist network meta-analysis of randomised controlled trials

Abstract Background Anthracyclines (ANT) are the cornerstone of multiple chemotherapy regimens but at risk potential cardiotoxicity. Previous RCTs have tested prophylactic effects cardioprotective agents to prevent ANT-related Unfortunately, attempts combine RCT findings in previous meta-analyses been heterogeneous, creating further uncertainty. There remains an unmet need determine role cardio-protective breast cancer. Purpose To assess comparative efficacy drugs patients with cancer using both Bayesian and frequentist analyses randomised controlled trials Methods We performed a systematic review four databases (CENTRAL, Cochrane Reviews, MEDLINE, SCOPUS), find evaluating cardio protective without prior ANT exposure. The population included was anthracycline naïve, were excluded if commenced post treatment. primary outcome mean change LVEF pre dosing. Results pooled approaches random models R statistical software. identified 12 from 2807 search results (n=1126, Age 51 years, dose 412m/m2, baseline 62.6%) comparisons including beta-blockers (BB) (n=9), Angiotensin Converting Enzyme inhibitors (ACEi)/Angiotensin Receptor Blockers (ARB) (n=3), combination BB + AA (n=2), spironolactone (n=1) statins (n=1). All had either intermediate or high bias, marked heterogeneity dosing monitoring. Overall, our network meta-analysis showed no statistically significant difference preservation between (1.3%, 95% credible interval [−0.20, 2.9]), (0.77, [−0.21, 1.8]), AABB (0.84 [−1.1, 2.8]), SPR (0.72, [−2.3, 3.7]) statin (0.60, [−2.4, 3.6]) when compared against placebo. After ranking for efficacy, ACEi/ARBs achieved most protection decline 1.3% [95% CI: −0.2, 2.9] although still not significant. Conversely, analysis benefit (Standardised Mean Difference (SMD) 1.32% [0.32, 2.33]) (SMD 0.76% [0.12, 1.4]). Conclusion demonstrated agents. In contrast, that may provide cardio-protection. quality data date is limited by bias RCA reporting. Larger clear definition required whether any drug class provides this setting. Funding Acknowledgement Type funding sources: None.