Efficacy of beta-blockers in preventing cardiotoxicity in breast cancer patients receiving anthracyclines: a GRADE-assessed systematic review and meta-analysis with trial sequential analysis
7 affiliations
- 1Department of Medicine, Eisenhower Medical Center , , ,
- 2Universidad del Valle de México , , ,
- 3Universidad de Sonora , , ,
- 4Centro de Estudios Universitarios Xochicalco Campus Tijuana , , ,
- 5Universidad Autónoma de Santo Domingo , ,
- 6Kern Medical Center , , ,
- 7Lucy Curci Cancer Center, Eisenhower Health , , ,
Abstract
Purpose: Anthracycline-induced cardiotoxicity remains an important complication in patients with breast cancer receiving systemic therapy, and effective preventive strategies remain limited. We conducted a systematic review and meta-analysis to evaluate the cardioprotective effects of beta-blockers in anthracycline-treated breast cancer patients.
Methods: Following PRISMA guidelines, Pubmed, Web of Science, CINAHL, and Cochrane were systematically searched, and the protocol was preregistered on PROSPERO (CRD420261366946). The primary outcome was left ventricular ejection fraction (LVEF), while the secondary outcome was E/A ratio. Certainty and robustness of the evidence were assessed using GRADE approach and trial sequential analysis (TSA). A meta-analysis was performed using R version 4.6.0, and heterogeneity was assessed using I ² statistics.
Results: A total of 8 studies including 772 patients were analyzed. Beta-blocker therapy was associated with significant preservation of LVEF vs. placebo or standard care (MD, 2.85; 95% CI, 0.58–5.12; p = 0.02; I ² 95%). No significant improvement was observed for E/A ratio (MD, 0.10; 95% CI, −0.12 to 0.31; p = 0.25; I ² 69.7%). However, sensitivity analysis resulted in a statistically significant pooled effect (MD = 0.16, 95% CI: 0.03 to 0.29, p = 0.01; I ² = 35.9%). TSA showed that the Z-curve crossed the monitoring boundaries favoring beta-blockers for LVEF; however, the required information size (RIS = 1,785) was not reached.
Conclusion: Beta-blockers were associated with preservation of systolic function in anthracycline-treated breast cancer patients. However, no significant benefit was observed for E/A ratio, and evidence regarding diastolic protection remains inconclusive. Larger, high-quality RCTs are needed to confirm these findings.
Systematic Review Registration: identifier CRD420261366946.
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BibTeX
@article{samperio2026efficacy,
title = {{Efficacy of beta-blockers in preventing cardiotoxicity in breast cancer patients receiving anthracyclines: a GRADE-assessed systematic review and meta-analysis with trial sequential analysis}},
author = {Victor M. Samperio and Lorena M. Murrieta Bruciaga and Jesús Antonio Castañeda Martínez and Vanessa Coronado Porchas and Alejandro Chen Liang and Yeison Cruz Castillo and Aishwarya Ghonge and Aishwarya Saripalli and Thomas Schulz},
journal = {Frontiers in cardiovascular medicine},
year = {2026},
month = oct,
doi = {10.3389/fcvm.2026.1926758},
url = {https://europepmc.org/article/PMC/PMC13690626},
note = {CC BY},
}
RIS
TY - JOUR
TI - Efficacy of beta-blockers in preventing cardiotoxicity in breast cancer patients receiving anthracyclines: a GRADE-assessed systematic review and meta-analysis with trial sequential analysis
AU - Victor M. Samperio
AU - Lorena M. Murrieta Bruciaga
AU - Jesús Antonio Castañeda Martínez
AU - Vanessa Coronado Porchas
AU - Alejandro Chen Liang
AU - Yeison Cruz Castillo
AU - Aishwarya Ghonge
AU - Aishwarya Saripalli
AU - Thomas Schulz
PY - 2026
DA - 2026/10/09
JO - Frontiers in cardiovascular medicine
DO - 10.3389/fcvm.2026.1926758
UR - https://europepmc.org/article/PMC/PMC13690626
AB - Purpose: Anthracycline-induced cardiotoxicity remains an important complication in patients with breast cancer receiving systemic therapy, and effective preventive strategies remain limited. We conducted a systematic review and meta-analysis to evaluate the cardioprotective effects of beta-blockers in anthracycline-treated breast cancer patients. Methods: Following PRISMA guidelines, Pubmed, Web of Science, CINAHL, and Cochrane were systematically searched, and the protocol was preregistered on PROSPERO (CRD420261366946). The primary outcome was left ventricular ejection fraction (LVEF), while the secondary outcome was E/A ratio. Certainty and robustness of the evidence were assessed using GRADE approach and trial sequential analysis (TSA). A meta-analysis was performed using R version 4.6.0, and heterogeneity was assessed using I ² statistics. Results: A total of 8 studies including 772 patients were analyzed. Beta-blocker therapy was associated with significant preservation of LVEF vs. placebo or standard care (MD, 2.85; 95% CI, 0.58–5.12; p = 0.02; I ² 95%). No significant improvement was observed for E/A ratio (MD, 0.10; 95% CI, −0.12 to 0.31; p = 0.25; I ² 69.7%). However, sensitivity analysis resulted in a statistically significant pooled effect (MD = 0.16, 95% CI: 0.03 to 0.29, p = 0.01; I ² = 35.9%). TSA showed that the Z-curve crossed the monitoring boundaries favoring beta-blockers for LVEF; however, the required information size (RIS = 1,785) was not reached. Conclusion: Beta-blockers were associated with preservation of systolic function in anthracycline-treated breast cancer patients. However, no significant benefit was observed for E/A ratio, and evidence regarding diastolic protection remains inconclusive. Larger, high-quality RCTs are needed to confirm these findings. Systematic Review Registration: identifier CRD420261366946.
SN - 2297-055X
ER -