Systematic Review and Meta-Analysis of Pharmacologic Cardioprotection in Breast Cancer Therapy: Evidence from Real-World Data

Benard Shehu; Klerida Shehu; Fatjona Kraja; Bledar Kraja

doi:10.15157/ijitis.2026.9.2.717-741

Authors

Benard Shehu ¹ Cardiology Service, University Hospital Centre “Mother Teresa”, Tirana, Albania; 2 Department of Preclinical Sciences, University of Medicine, Tirana, Albania https://orcid.org/0009-0009-9250-1454
Klerida Shehu Faculty of Technical Medical Sciences, University of Medicine, Tirana, Albania. https://orcid.org/0009-0005-7443-8368
Fatjona Kraja Oncology Service, University Hospital Center “Mother Teresa”, Tirana, Albania. https://orcid.org/0000-0002-8718-2948
Bledar Kraja Department of Preclinical Sciences, University of Medicine, Tirana, Albania. https://orcid.org/0000-0001-7685-8394

DOI:

https://doi.org/10.15157/ijitis.2026.9.2.717-741

Keywords:

Breast Neoplasms, Anthracyclines, Trastuzumab, Heart Diseases, Chemically Induced, Echocardiography

Abstract

Pharmacologic cardioprotection during anthracycline and/or anti‑HER2 therapy for breast cancer remains incompletely characterized, particularly in real‑world settings. This study synthesizes trial evidence and validates it against an Albanian cohort to define the potential benefit and residual burden of cardiotoxicity. A random‑effects meta‑analysis of three comparative trials demonstrated that prophylactic cardioprotective medications were associated with a significant attenuation of left ventricular ejection fraction (LVEF) decline (pooled mean difference = 2.45 percentage points, 95% CI 1.56–3.34; I² = 21.8%). In a parallel retrospective analysis of 314 Albanian breast cancer patients, symptomatic cardiotoxicity occurred in 16.6%, and a clinically relevant ≥10‑point LVEF decline within 12 months was observed in 12.1%. These findings confirm a modest but consistent cardioprotective effect from prophylactic interventions in clinical trials, yet the substantial real‑world burden affecting approximately one in six patients symptomatically and one in eight with significant LVEF decline highlights a critical gap between trial efficacy and routine practice, underscoring the need for systematic implementation of cardioprotective strategies.