Doxorubicin cardiotoxicity in children: reduced incidence of cardiac dysfunction associated with continuous-infusion schedules.
We retrospectively reviewed the medical records of 97 children (59 boys and 38 girls) with a median age of 13 +/- 4 years who had been treated with continuous infusion of doxorubicin at a dosage of 60 mg/m2 over 24 h (61 patients) or at a dosage of 75 mg/m2 over 72 h (36 patients). The drug was administered every 3 weeks. The cardiac status of patients was evaluated as a baseline and every 6 months during, and following therapy (median, 30.5 months). The evaluations included M-mode and two-dimensional echocardiography. Congestive heart failure developed in only one patient in this series, an 8-year-old girl who ultimately died of her cardiac complication. This incidence of doxorubicin-induced cardiotoxicity was compared with that seen in a control group of pediatric patients previously treated with doxorubicin at similar dosages but with a rapid infusion. The result compared favorably to the 13% incidence of cardiotoxicity (p = 0.03) and 7% mortality (p < 0.01) in the control group. No changes in the levels of tumor response were noted in children treated by continuous infusion when compared with historical controls. Continuous-infusion schedules of doxorubicin thus result in fewer incidences of cardiotoxicity in children and should be considered for wider application in pediatric cancer patients receiving doxorubicin.
Berrak
S G
SG
Departments of Medical Specialties and Melanoma/Sarcoma and the Division of Pediatrics, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
Ewer
M S
MS
Jaffe
N
N
Pearson
P
P
Ried
H
H
Zietz
H A
HA
Benjamin
R S
RS
D000293:Adolescent; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects*; D004334:Drug Administration Schedule; D004562:Electrocardiography; D005260:Female; D006321:Heart / Q000187:drug effects*; D006333:Heart Failure / Q000139:chemically induced / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D007223:Infant; D007262:Infusions, Intravenous; D008297:Male; D009369:Neoplasms / Q000188:drug therapy; D012189:Retrospective Studies; D012307:Risk Factors
D000970:Antineoplastic Agents; D004317:Doxorubicin