Prophylactic use of ACEIs, ARBs and BBs in anthracycline and trastuzumab induced cardiotoxicity in adult cancer patients: A systematic review

Background: Cancer therapy related cardiac dysfunction (CTRCD) poses a significant challenge to the treatment of cancer patients receiving cardiotoxic chemotherapeutic regimen like anthracyclines and human epidermal growth factor receptor 2 (HER2) inhibitors like trastuzumab. This systematic review evaluated the efficacy and safety of conventional heart failure medications—angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and beta-blockers (BBs)—in preventing CTRCD in adults undergoing such therapies. Method: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, 12 randomized controlled trials (RCTs) involving 1,571 patients were analyzed from PubMed, Scopus and Embase. Primary outcomes included changes in left ventricular ejection fraction (LVEF), biomarkers like Troponin, atrial/brain natriuretic peptide (ANP/BNP) level and electrocardiograph (ECG), before and after chemotherapy. Secondary outcomes included total mortality and development of symptomatic heart failure, either necessitating treatment initiation or hospitalization. Results: Several studies demonstrated cardioprotective effects after the use of the aforementioned medications. Biomarker-guided approaches using troponin yielded inconsistent results, and combination therapy did not consistently outperform monotherapy. Most interventions were well tolerated, with few adverse events such as bradycardia and hypotension. Conclusion: Conventional heart failure medications such as ACEIs, ARBs, and BBs may offer selective benefit. However, current evidence is heterogeneous and does not support their routine prophylactic use. Future large-scale, long-term trials with standardized cardiac endpoints and patient-specific risk stratification are essential to guide clinical practice in cardio-oncology.