Abstract P5-14-06: Statins to mitigate cardiotoxicity in breast cancer patients treated with anthracyclines and/or trastuzumab: A systematic review and meta-analysis
Authors: Vo Jacqueline B , Abovich Arielle , Obasi Mary , Gao Yawen , Nohria Anju , Asnani Aarti , Partridge Ann H 
Published: March 2020

Abstract
Background: Due to advances in treatment and early detection, nearly 90% of women with breast cancer are living at least 5 years following their diagnosis. Yet, there is a risk for cardiotoxicity as a result of cancer treatments such as anthracyclines and/or trastuzumab. Recent evidence has demonstrated the potential for statins to mitigate the risk of cardiotoxicity. This systematic review and meta-analysis was aimed to address the research question of: Does statin use lower the risk of cardiotoxicity among breast cancer patients who receive treatment with anthracyclines and/or trastuzumab? Methods: A systematic review of the literature was conducted using the databases PubMed, Embase, Web of Science, ClinicalTrials.gov, and Cochrane Central. Two reviewers independently performed study selection and data extraction. Five studies were identified, of which only one was a prospective randomized controlled trial; all examined statin use among breast cancer patients treated with anthracyclines and/or trastuzumab; four studies examined the primary outcome of cardiotoxicity defined as 1) incidence of heart failure or 2) having a reduction in left ventricular ejection fraction of &gt;10% from baseline to an absolute value of &lt;50%; and three studies included the secondary outcome of mean change in left ventricular ejection fraction from baseline (before statin use) to the time of collected outcome. Pooled relative risks and weighted mean differences using study-specific estimates were calculated, and a random-effects model using inverse variance weighting was applied. Results: Data were available on 890 patients (two studies also included gastric cancer, leukemia, and lymphoma), all treated with anthracyclines and/or trastuzumab. For the primary outcome of cardiotoxicity, there was a decreased risk of cardiotoxicity in patients treated with statins versus control (6.85% vs 13.89%, relative risk of 0.49 (95% CI 0.31 to 0.79), p = 0.003). For the secondary outcome, there was a smaller decline in left ventricular ejection fraction from baseline among statin users compared to controls with risk difference of 5.35% (95% CI 2.48 to 8.21), p &lt; 0.001. Sensitivity analyses in studies restricted to breast cancer patients showed consistent results. Conclusions: Statins are associated with decreased overall risk of cardiotoxicity and mitigate changes in left ventricular ejection fraction among cancer patients treated with anthracyclines and/or trastuzumab. While small sample sizes and retrospective design for most studies are a limitation of this meta-analyses and further research is warranted, statin use is a potential solution to mitigate cardiotoxicity from breast cancer treatment.
Citation Format: Jacqueline B Vo, Arielle Abovich, Mary Obasi, Yawen Gao, Anju Nohria, Aarti Asnani, Ann H Partridge. Statins to mitigate cardiotoxicity in breast cancer patients treated with anthracyclines and/or trastuzumab: A systematic review and meta-analysis [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-14-06.