Utility of sacubitril/valsartan in the prevention of cancer therapy–related cardiac dysfunction (CTRCD) in patients receiving cardiotoxic chemotherapy agents: A systematic review and meta-analysis.

Abstract

e24038 Background: Cancer therapy–related cardiac dysfunction (CTRCD) is a recognized adverse effect of cardiotoxic chemotherapy agents like anthracyclines and HER2-targeted therapies. Neurohormonal blockage utilizing ACE inhibitors and beta blockers has been studied before. The efficacy of sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor, for primary prevention of CTRCD is still undetermined. Methods: A systematic search of PubMed, Embase, and the Cochrane Library was done to identify randomized controlled trials evaluating the cardioprotective effects of Entresto compared with placebo in cancer patients receiving chemotherapy. Studies reporting cancer therapy-related cardiac dysfunction (CTRCD) or hypotension were included. Data were pooled using a random-effects model in RevMan Version 5.4. Risk ratios (RR) and risk differences (RD) with 95% confidence intervals (CI) were calculated for dichotomous outcomes. Heterogeneity was assessed using the I² statistic and Chi² test. Results: Three randomized trials including 352 patients were analyzed for CTRCD. Pooled RD showed that sacubitril/valsartan significantly reduced the absolute risk of CTRCD compared with placebo (RD = −0.19; 95% CI −0.28 to −0.11; p < 0.00001; I² = 24%), corresponding to an approximate number needed to treat (NNT) of 5. The pooled RR was not statistically significant (RR = 0.44; 95% CI 0.15–1.32; p = 0.14; I² = 70%), reflecting substantial heterogeneity in relative effects across studies. For hypotension, two trials including 252 patients reported events. Entresto significantly increased the risk of hypotension (RR = 3.64; 95% CI 1.23–10.79; p = 0.02; I² = 0%), indicating a consistent adverse effect across studies. Conclusions: This study shows that sacubitril/valsartan may be useful in cardio protection, but it is essential to consider the heterogeneity and the high incidence of hypotension when choosing this drug, as more research is needed to check its safety profile.