Blood cancers

Prescribe statins to prevent anthracycline cardiotoxicity: study

Prof. Marielle Scherrer-Crosbie

Statins should be considered as cardioprotective agents for blood cancer patients receiving anthracycline therapy because the lipid-lowering drugs reduce the risk of cardiotoxicity, US researchers say.

Study results presented at the American College of Cardiology’s Annual Scientific Session (ACC 23) showed that statin therapy was associated with a reduction in risk of developing heart failure in patients receiving anthracyclines for Hodgkin’s or Non-Hodgkin’s lymphoma.

A research team at the University of Pennsylvania enrolled 300 patients with lymphoma undergoing treatment with anthracyclines at a median dose of 300 mg/m2 . Half were randomised to take 40 mg of atorvastatin and half took a placebo daily, starting before their first dose of anthracyclines and continuing for one year.

The trial’s primary endpoint was the proportion of patients who experienced a decline in LVEF of 10% or more (to less than 55%, near the lower limit of normal LVEF) from baseline to one year. This outcome was three times less common in patients in the atorvastatin group compared to the placebo group (9% vs 22%, P=0.002, Odds Ratio 2.9, 95% CI 1.4 – 6.4)

The trial’s secondary endpoint, a reduction in LVEF of 5% or more to less than 55% from baseline to one year, was also significant in favour of statin therapy (13% in the atorvastatin group and 29% in the placebo group, P=0.001).

At one year, patients who took statins had an average ejection fraction that was 1.3% higher than patients who took a placebo. This absolute difference between the two groups was statistically significant; however, researchers said it is not a large enough magnitude to be clinically relevant when viewed across the entire patient population, though the difference may be greater among subgroups of patients.

There was no significant difference in the rates of adverse events such as muscle pain or renal failure between statin treatment group and placebo.

The researchers said the findings suggested many patient groups treated with anthracyclines  might benefit from statins to prevent cardiac systolic dysfunction.

“We believe that patients with lymphoma who are treated with anthracyclines and are at high risk of cardiac dysfunction and heart failure would benefit from statin therapy,” said lead investigator Prof. Marielle Scherrer-Crosbie, of the Hospital of the University of Pennsylvania.

“I think it’s an impactful study that will lead to more prescription of statins in patients,”she added

She said further studies are needed to elucidate which subgroups of patients may benefit most from statin use and examine whether statin therapy prevents symptomatic heart failure.

“This effect will also need to be confirmed in terms of symptomatic heart failure, but the endpoint we chose is clinically relevant because those rates of decline in LVEF are associated with later symptomatic heart failure,” Prof Scherrer-Crosbie added.

The researchers noted there is currently only one approved  cardioprotectant agent to reduce anthracycline-associated cardiotoxicity, (dexrazoxane, Zinecard) which has limited use due to potential secondary effects.

A recent Australian study found that rates of cardiotoxicity were around 20% among patients with lymphomas or leukaemias who were exposed to anthracyclines.

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