A systematic review of prospective randomized controlled trials was conducted to compare cardiotoxicity of anthracyclines in patients with breast cancer. Anthracyclines play a broad and important role in operable or metastatic breast cancer; however, cardiotoxicity can lead to potentially clinically meaningful treatment delays or discontinuations.
In this study, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Google Scholar were searched for prospective randomized controlled trials comparing nonanthracycline based regimens (NON), doxorubicin (DOX), epirubicin (EPI), and liposomal doxorubicin (LD). Primary outcome measure was cardiac events grade 3 or greater (CE3) based on Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0. The search produced 19 trials that met eligibility criteria and were included in this Bayesian network meta-analysis.
Study findings indicate that CE3 rates were higher with DOX than with NON. LD statistically trended to lower cardiac event rates than DOX and appears to be the least cardiotoxic. Overall, incidence of CE3 with any type of anthracycline was low, and these drugs can be safely administered if cumulative dose limits are not exceeded.