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Minerva Medica 2022 June;113(3):551-7

DOI: 10.23736/S0026-4806.22.08029-6


language: English

Effectiveness of sacubitril-valsartan in patients with cancer therapy-related cardiac dysfunction: a systematic review of clinical and preclinical studies

Andre R. DURAES 1, 2 , Yasmin de SOUZA LIMA BITAR 1, 2, Mansueto G. NETO 1, 2, Evandro T. MESQUITA 3, Jeffrey S. CHAN 4, Gary TSE 5, 6, 7, Tong LIU 8, Edimar A. BOCCHI 4, Giuseppe BIONDI-ZOCCAI 9, 10, Leonardo ROEVER 11

1 Faculty of Medicine, Federal University of Bahia, Salvador, Brazil; 2 Federal University of Bahia, Salvador, Brazil; 3 Antônio Pedro University Hospital, Fluminense Federal University, Rio de Janeiro, Brazil; 4 Unit of Heart Failure, Cardiology Hospital of Sao Paulo, Sao Paulo, Brazil; 5 Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China; 6 Laboratory of Cardiovascular Physiology, Unit of Heart Failure and Structural Heart Disease, Hong Kong, China; 7 Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China; 8 Kent and Medway Medical School, Canterbury, UK; 9 Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy; 10 Mediterranea Cardiocentro, Naples, Italy; 11 Department of Clinical Research, Federal University of Uberlandia, Minas Gerais, Brazil

INTRODUCTION: Cancer therapy-related cardiac dysfunction (CTRCD) is a critical problem with an impact on both oncological and cardiovascular prognosis, especially when it prevents patients from receiving cancer treatment. However, there are very limited data on the efficacy of sacubitril/valsartan in the prevention and treatment of cardiotoxicity. This systematic review aimed to evaluate the potential benefit of sacubitril/valsartan in patients with CTRCD.
EVIDENCE ACQUISITION: The databases included MEDLINE, Embase, LILACS, Scopus and Cochrane Central up to January 20, 2022. All pre-clinical and clinical studies including observational studies (cohorts, case-control, cross-sectional and case reports) that used sacubitril/valsartan for prevention or treatment of CTRCD. The primary effectiveness endpoints was CTRCD, defined as a clinically significant change in left ventricular ejection fraction (LVEF) at the end of the follow-up.
EVIDENCE SYNTHESIS: And after applying the eligibility criteria, 12 articles (9 in humans and 3 preclinical studies) were included in this systematic review. The 3 preclinical studies demonstrated beneficial effects in preventing, attenuating and/or delaying the onset of myocardial damage at the cellular level, ventricular dysfunction and remodeling. Regardind human studies, most of them were composed of case reports. The largest study consisted of a retrospective multicentric cohort with 64 patients.
CONCLUSIONS: All clinical studies have demonstrated that used Sac/Val in human showed a significant increase in LVEF, and when reported, a reduction in left ventricular volume and NT-proBNP (or BNP). Randomized clinical trials are needed to confirm this hypothesis.

KEY WORDS: Sacubitril and valsartan sodium hydrate drug combination; Heart failure; Neoplasms; Cardiotoxicity

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