Sacubitril-Valsartan in Cancer Therapy-Induced Heart Failure: A Systematic Review and Meta-Analysis of Functional and Hemodynamic Parameters

Background: Cancer therapy-induced cardiotoxicity (CTRCD), in the form of heart failure with reduced ejection fraction (HFrEF), is being increasingly recognized. However, the potential benefits of sacubitril/valsartan (S/V) in managing HFrEF secondary to CTRCD remain unclear.

Objective: We performed a systematic review and meta-analysis to assess the effectiveness of S/V in preventing cardiotoxicity.

Methods: We searched PubMed, Embase, and Cochrane databases for studies evaluating S/V in patients with HFrEF due to CTRCD and reporting the following outcomes: (1) NYHA class; (2) NT-ProBNP and (3) echocardiographic measurements, specifically left ventricular ejection fraction (LVEF), global longitudinal strain (GLS) and E/e' ratio. Statistical analyses were performed using RStudio software. Heterogeneity was assessed using I² statistics.

Results: We included 257 patients from six studies. All patients received S/V. The mean patient age was 63 ± 8 years, and 85% of patients had breast cancer. The mean LVEF was 34±7% at baseline. S/V significantly improved NYHA class compared to baseline (MD -0.7; 95% CI -1.2 to -0.3; p<0.01), NT-proBNP (MD -985.1 pg/mL; 95% CI -1231.3 to -739.1; p<0.01), GLS (MD -2.5%; 95% CI -3.6 to -1.4; p<0.01;), and E/e' (MD -1.99; 95% CI 3.7 to -0.1; p=0.03). LVEF (MD 7.3%; 95% CI 5.4 to 9.2; p<0.01) with S/V treatment relative to baseline.

Conclusion: In patients with HFrEF due to CTRCD, S/V significantly improved the clinical and echocardiographic parameters of left ventricular systolic and diastolic functions.