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Alshammari A, Qasem BA, Almatrafi NA, Alharbi LM, Alhuthali AA, Khobrani AA, Alnuhait M. Case Series: Sacubitril/Valsartan Role for Chemotherapy-Induced Cardiotoxicity: An in-Depth Investigation in Saudi Arabia. Int Med Case Rep J 2024; 17:35-41. [PMID: 38264456 PMCID: PMC10804285 DOI: 10.2147/imcrj.s448913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 01/16/2024] [Indexed: 01/25/2024] Open
Abstract
Background Chemotherapy-induced cardiotoxicity is a significant problem, ranking as the second most frequent cause of mortality in cancer patients. This adverse outcome encompasses many cardiovascular problems, such as heart failure. Sacubitril/valsartan has shown potential in the management of heart failure, however, its effectiveness in treating chemotherapy-induced heart failure has not been extensively explored. We performed a case series to investigate the safety and effectiveness of sacubitril/valsartan in treating chemotherapy-induced cardiomyopathy in Saudi Arabia. Methods The case series was conducted at a single medical center in Makkah, Saudi Arabia. The data gathered included patient demographics, clinical features, laboratory results, echocardiographic findings, and medication information. The data underwent analysis using descriptive statistics. Results Out of the total of eight patients who were part of the investigation, a notable majority of six individuals exhibited substantial enhancements in their ejection fraction (EF) after receiving sacubitril/valsartan medication. Conclusion Our case series provides significant insights by revealing improvements in ejection fraction (EF) in six out of eight patients who had chemotherapy-induced cardiomyopathy after receiving sacubitril/valsartan treatment.
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Affiliation(s)
- Abdullah Alshammari
- Clinical Pharmacy Department, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Basmah Ahmed Qasem
- Clinical Pharmacy Department, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Nouf Ahmed Almatrafi
- Clinical Pharmacy Department, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Lujain Mofareh Alharbi
- Clinical Pharmacy Department, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | | | | | - Mohammed Alnuhait
- Clinical Pharmacy Department, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
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Huang Y, Zhang Y, Xu W, Fang C, Zhou H, Ma L. Effectiveness of sacubitril/valsartan for patients with cancer therapy‑related cardiac dysfunction: A systematic review of descriptive studies. Oncol Lett 2023; 25:108. [PMID: 36817048 PMCID: PMC9932629 DOI: 10.3892/ol.2023.13694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/11/2023] [Indexed: 02/05/2023] Open
Abstract
The present review assessed the effectiveness of sacubitril/valsartan in patients with cancer therapy-related cardiac dysfunction (CTRCD). Studies that included patients with CTRCD treated with sacubitril/valsartan were retrieved from the Medline, Embase, Cochrane Library and ClinicalTrials databases. Only descriptive studies on sacubitril/valsartan for patients with CTRCD were included in this review; therefore, all variables were qualitatively analyzed. A total of five studies comprising 109 patients were included. The duration from anticancer therapy to heart failure (HF) or from HF to the use of sacubitril/valsartan exhibited interindividual variations. In patients with CTRCD who were treated with sacubitril/valsartan, the left ventricular ejection fraction improved, N-terminal pro-B-type natriuretic peptide levels decreased and exercise tolerance improved, as indicated by the change in the New York Heart Association functional class. These clinical, echocardiographic and biochemical improvements were found for different dosages or treatment durations of sacubitril/valsartan. No difference was found between the baseline and follow-up serum creatinine and potassium levels. These findings, which are limited to descriptive studies, support the effectiveness of sacubitril/valsartan in improving heart function following CTRCD.
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Affiliation(s)
- Yun Huang
- Department of Pharmacy, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang 315040, P.R. China
| | - Yuyu Zhang
- Department of Pharmacy, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang 315040, P.R. China
| | - Weifeng Xu
- Department of Cardiology, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang 315040, P.R. China
| | - Chongbo Fang
- Department of Pharmacy, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang 315040, P.R. China
| | - Hua Zhou
- Department of Pharmacy, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang 315040, P.R. China,Correspondence to: Mr. Hua Zhou or Dr Lili Ma, Department of Pharmacy, Ningbo Medical Center Lihuili Hospital, 57 Xingning Road, Ningbo, Zhejiang 315040, P.R. China, E-mail:
| | - Lili Ma
- Department of Pharmacy, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang 315040, P.R. China,Correspondence to: Mr. Hua Zhou or Dr Lili Ma, Department of Pharmacy, Ningbo Medical Center Lihuili Hospital, 57 Xingning Road, Ningbo, Zhejiang 315040, P.R. China, E-mail:
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Duraes AR, de Souza Lima Bitar Y, Neto MG, Mesquita ET, Chan JS, Tse G, Liu T, Bocchi EA, Biondi-Zoccai G, Roever L. Effectiveness of sacubitril-valsartan in patients with cancer therapy-related cardiac dysfunction: a systematic review of clinical and preclinical studies. Minerva Med 2022; 113:551-557. [PMID: 35156789 DOI: 10.23736/s0026-4806.22.08029-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
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.
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Affiliation(s)
- Andre R Duraes
- Faculty of Medicine, Federal University of Bahia, Salvador, Brazil -
- Federal University of Bahia, Salvador, Brazil -
| | - Yasmin de Souza Lima Bitar
- Faculty of Medicine, Federal University of Bahia, Salvador, Brazil
- Federal University of Bahia, Salvador, Brazil
| | - Mansueto G Neto
- Faculty of Medicine, Federal University of Bahia, Salvador, Brazil
- Federal University of Bahia, Salvador, Brazil
| | - Evandro T Mesquita
- Antônio Pedro University Hospital, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Jeffrey S Chan
- Unit of Heart Failure, Cardiology Hospital of Sao Paulo, Sao Paulo, Brazil
| | - Gary Tse
- 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
- Laboratory of Cardiovascular Physiology, Unit of Heart Failure and Structural Heart Disease, Hong Kong, China
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Tong Liu
- Kent and Medway Medical School, Canterbury, UK
| | - Edimar A Bocchi
- Unit of Heart Failure, Cardiology Hospital of Sao Paulo, Sao Paulo, Brazil
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Leonardo Roever
- Department of Clinical Research, Federal University of Uberlandia, Minas Gerais, Brazil
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Canale ML, Coviello K, Solarino G, Del Meglio J, Simonetti F, Venturini E, Camerini A, Maurea N, Bisceglia I, Tessa C, Casolo G. Case Series: Recovery of Chemotherapy-Related Acute Heart Failure by the Combined Use of Sacubitril Valsartan and Wearable Cardioverter Defibrillator: A Novel Winning Combination in Cardio-Oncology. Front Cardiovasc Med 2022; 9:801143. [PMID: 35299980 PMCID: PMC8923038 DOI: 10.3389/fcvm.2022.801143] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/24/2022] [Indexed: 11/28/2022] Open
Abstract
Effective anticancer treatments have dramatically improved the outcome of patients with cancer, but cardiac toxicity reduces their clinical efficacy in a non-negligible percentage of patients. Sacubitril/valsartan is a new paradigm in the treatment of chronic heart failure, with a reduced ejection fraction due to the enhancement of natriuretic peptides' properties when coupled with a blocking effect on the angiotensin II type 1 (AT1) receptors. As with other clinical conditions of heart failure with potentially reversible declines in cardiac function, a wearable cardioverter defibrillator (WCD) is a valid tool for protection against sudden death until recovery occurs. We report a case series of four patients with chemotherapy-related acute cardiac failure with severely reduced cardiac function. They were successfully treated with sacubitril/valsartan while being protected from malignant arrhythmias using a wearable cardioverter defibrillator until the recovery of cardiac function. Sacubitril/valsartan was confirmed to be effective in anthracycline-related cardiac toxicity and the wearable cardioverter defibrillator should be considered as a support tool even in the oncology patient.
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Affiliation(s)
- Maria Laura Canale
- Division of Cardiology, Azienda USL Toscana Nord-Ovest, Versilia Hospital, Lido di Camaiore, Italy
- *Correspondence: Maria Laura Canale
| | - Katia Coviello
- Division of Cardiology, Azienda USL Toscana Nord-Ovest, Versilia Hospital, Lido di Camaiore, Italy
| | - Gianluca Solarino
- Division of Cardiology, Azienda USL Toscana Nord-Ovest, Versilia Hospital, Lido di Camaiore, Italy
| | - Jacopo Del Meglio
- Division of Cardiology, Azienda USL Toscana Nord-Ovest, Versilia Hospital, Lido di Camaiore, Italy
| | - Federico Simonetti
- Hematology, Azienda USL Toscana Nord-Ovest, Versilia Hospital, Lido di Camaiore, Italy
| | - Elio Venturini
- Cardiac Rehabilitation Unit, Azienda USL Toscana Nord-Ovest, Civil Hospital, Cecina, Italy
| | - Andrea Camerini
- Medical Oncology, Azienda USL Toscana Nord-Ovest, Versilia Hospital, Lido di Camaiore, Italy
| | - Nicola Maurea
- S.C. Cardiologia, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Irma Bisceglia
- Servizi Cardiologici Integrati, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
| | - Carlo Tessa
- Division of Radiology, Azienda USL Toscana Nord-Ovest, Nuovo Ospedale Apuano, Massa, Italy
| | - Giancarlo Casolo
- Division of Cardiology, Azienda USL Toscana Nord-Ovest, Versilia Hospital, Lido di Camaiore, Italy
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Xi Q, Chen Z, Li T, Wang L. Time to switch angiotensin-converting enzyme inhibitors/angiotensin receptor blockers to sacubitril/valsartan in patients with cancer therapy-related cardiac dysfunction. J Int Med Res 2022; 50:3000605211067909. [PMID: 34986674 PMCID: PMC8802132 DOI: 10.1177/03000605211067909] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Advances in cancer therapy have resulted in more cancer therapy-related cardiac dysfunction (CTRCD), which is the main cause of death in older female survivors of breast cancer. Traditionally, guideline-recommended medications for heart failure, such as beta-blockers and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs), are commonly used to prevent or attenuate CTRCD. However, sometimes their effectiveness is not satisfactory. Recently, the drug combination of sacubitril plus valsartan has been proven to be more beneficial for heart failure with reduced ejection fraction in the long term compared with an ACEI/ARB alone. However, there is a lack of evidence of the efficacy and safety of this drug combination in CTRCD. We report a case of worsening CTRCD, despite treatment with traditional medications, in which the patient improved after changing perindopril to sacubitril/valsartan. The patient's heart function greatly improved after changing this ACEI to sacubitril/valsartan. Changing an ACEI/ARB to sacubitril/valsartan in patients with worsening chemotherapy-induced heart failure is appropriate. Further studies with a high level of evidence are required to assess the efficacy and safety of sacubitril/valsartan for CTRCD.
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Affiliation(s)
- Qianlan Xi
- Internal Medicine, 23457Memorial Hospital West, Memorial Healthcare System, Memorial Hospital West, Florida, USA
| | - Zijun Chen
- Department of Cardiology, 12550Chongqing Medical University, The Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Tingming Li
- Department of Cardiology, 12550Chongqing Medical University, The Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Liya Wang
- Department of Gynaecology and Obstetrics, The Sixth People's Hospital of Chongqing, Chongqing, China
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Frey MK, Arfsten H, Pavo N, Han E, Kastl S, Hülsmann M, Gyöngyösi M, Bergler-Klein J. Sacubitril/valsartan is well tolerated in patients with longstanding heart failure and history of cancer and improves ventricular function: real-world data. CARDIO-ONCOLOGY 2021; 7:35. [PMID: 34645527 PMCID: PMC8513362 DOI: 10.1186/s40959-021-00121-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/07/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Sacubitril/valsartan has been shown to significantly reduce cardiovascular mortality and hospitalizations due to heart failure in patients with reduced ejection fraction (HFrEF) when compared to enalapril. Data about sacubitril/valsartan in patients with a history of cancer are scarce, as these patients were excluded from the pivotal trial, PARADIGM-HF. The aim of the current study was to assess tolerability of sacubitril/valsartan in patients with a history of cancer. METHODS We identified 225 patients at our heart failure out-patient unit who fulfilled the indication criteria to receive sacubitril/valsartan. Out of these, 9.3% (n = 21) had a history of histologically confirmed cancer. Oncologic surgery was performed in 16 (76.2%) patients, 11 (52.4%) patients received previous antineoplastic therapy and 9 patients (42.9%) radiation. RESULTS Sacubitril/valsartan was withdrawn in 3 of 21 patients (14.3%) because of dizziness (n = 2) or pruritus (n = 1). After a median follow-up of 12 months (range 1-34 months), NYHA functional class improved significantly from NYHA 3 to NYHA 2 (mean -0.6, p = 0.006) and left ventricular ejection fraction as assessed by echocardiography increased significantly from 26.8 ± 5.4% to 39.2 ± 10% (mean + 12%, CI 95% [8.4-16.4], p = 0.0004). NT-proBNP was significantly reduced (baseline median 2774 pg/ml, range 1441 - 12,982 vs follow-up 1266 pg/ml, range 199-6324, p = 0.009). There was no significant change in creatinine levels (1.18 ± 0.4 vs 1.22 ± 0.4 mg/dl; mean + 0.005 mg/dl, CI 95% [-0.21- 0.12], p = 0.566). CONCLUSIONS In our pilot study we show that sacubitril/valsartan is generally well tolerated in patients with HFrEF and history of cancer. Importantly, even patients with long-standing cardiotoxicity induced heart failure can be treated and up-titrated with sacubitril/valsartan to usual target dosages, leading to improvement in LV function and biomarkers. Larger studies are needed to confirm these findings in cancer patients with cardiotoxicity.
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Affiliation(s)
- Maria Klara Frey
- Department of Cardiology, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Henrike Arfsten
- Department of Cardiology, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Noemi Pavo
- Department of Cardiology, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Emilie Han
- Department of Cardiology, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Stefan Kastl
- Department of Cardiology, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Martin Hülsmann
- Department of Cardiology, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Mariann Gyöngyösi
- Department of Cardiology, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Jutta Bergler-Klein
- Department of Cardiology, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Lupi A, Ariotti S, De Pace D, Ferrari I, Bertuol S, Monti L, Guasti L, Gaudio GV, Campana C. Sacubitril/Valsartan to Treat Heart Failure in a Patient with Relapsing Hairy Cell Leukaemia: Case Report. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2021; 15:11795468211010706. [PMID: 33911910 PMCID: PMC8050758 DOI: 10.1177/11795468211010706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 03/12/2021] [Indexed: 12/11/2022]
Abstract
Experience with angiotensin-receptor neprilysin inhibitors (ARNI) in oncologic
patients with heart failure (HF) is limited. We report a case of ARNI started as
first-choice therapy in a patient with relapsing hairy cell leukaemia (HCL) and
HF with depressed left ventricular ejection fraction (LVEF). A middle-aged male,
previously treated with rituximab for HCL, was scheduled for cardiologic
screening before starting a new antineoplastic therapy for cancer relapse. The
patient had symptomatic HF with reduced LVEF and high NT-proBNP levels. In this
patient, early ARNI treatment was well tolerated and produced a rapid and
durable improvement of symptoms, LVEF and NT-proBNP levels. Consequently, the
oncologic team could start an experimental treatment with obinutuzumab, with
complete HCL remission. In conclusion, in this patient with HCL and HF, ARNI
therapy was safe and effective, contributing to undelayed cancer treatment.
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Affiliation(s)
- Alessandro Lupi
- Department of Cardiology, ASL14 Verbano-Cusio-Ossola, Ospedale Castelli, Verbania, Italy
| | - Sara Ariotti
- Department of Cardiology, ASL14 Verbano-Cusio-Ossola, Ospedale Castelli, Verbania, Italy
| | - Doranna De Pace
- Department of Cardiology, ASL14 Verbano-Cusio-Ossola, Ospedale Castelli, Verbania, Italy
| | - Irene Ferrari
- Department of Cardiology, ASL14 Verbano-Cusio-Ossola, Ospedale Castelli, Verbania, Italy
| | - Stefano Bertuol
- Department of Cardiology, ASL14 Verbano-Cusio-Ossola, Ospedale Castelli, Verbania, Italy
| | - Lorenzo Monti
- Radiology and Cardiology Department, Humanitas Research Hospital, Rozzano (MI), Italy
| | - Luigina Guasti
- Research Center on Dyslipidemia, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | - Carlo Campana
- Cardiology Department, Sant'Anna Hospital, Como, Italy
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