Anthracyclines are widely used in treating various malignancies but are limited by dose-dependent cardiotoxicity, leading to cardiomyopathy and heart failure. The activation of the cardiac renin-angiotensin system by anthracyclines increases cardiac oxidative stress, thus suggesting that Angiotensin-Converting Enzyme Inhibitors (ACEIs) can mitigate this damage. This systematic review and meta-analysis evaluate the efficacy and safety of ACEIs in preventing anthracycline-induced cardiomyopathy in cancer patients. 

A comprehensive search of four databases, PubMed, Embase, Cochrane, and ScienceDirect, identified Randomized Controlled Trials (RCTs) assessing ACEIs for this purpose. The RCTs focused on Left Ventricular Ejection Fraction (LVEF) changes as the primary outcome and adverse events and significant cardiac events as secondary outcomes. Random effect model meta-analysis with a 95% Confidence Interval (CI) was performed using RevMan4.5.1 software.

Nine RCTs involving 881 cancer patients were analyzed. At six months, ACEIs significantly improved LVEF by 7.94% compared to controls (Weighted Mean Difference (WMD): 7.93%, 95% CI: 3.18-12.67%, p=0.001). At 12 months, 4.08% improvement was observed, without statistical significance (WMD: 4.08%, 95% CI: -0.53 to 8.69, p=0.08, I² = 98%). The incidence of heart failure differed insignificantly between the ACEI and control groups (odds ratio 0.47, 95% CI [0.03, 7.64], P = 0.60, I² = 92%) and (odds ratio 0.20, 95% CI [0.03, 1.60], P = 0.13, I² = 48%) respectively. The incidence of arrhythmias was significantly lower in the ACEI group vs. the control group, with a 0.14 odds ratio (95% CI [0.03, 0.66], P = 0.01, I² = 0%).

In conclusion, ACEIs show potential in reducing short-term anthracycline-induced cardiotoxicity without significant adverse effects. This promising outcome, coupled with the need for ongoing research, underscores the potential of ACEIs to offer promising outcomes for patients undergoing anthracycline chemotherapy. The confidence in the potential of ACEIs is a reassuring sign for the future of cancer treatment.