Cardiovascular considerations with anthracycline use in patients with cancer.
Anthracyclines are important chemotherapeutic agents that are used for the treatment of various malignancies in both adults and children, but their usefulness has been limited by cardiotoxicity that is usually dose related. Oxidative injury appears to be the cause of myocardial dysfunction when using these drugs. Screening for early myocardial injury with troponin testing, echocardiography, and radionuclide examinations has reduced the incidence of chronic cardiac dysfunction. Various anthracycline analogues have been developed that have less cardiotoxicity. Dexrazoxane, an iron chelator, and the radioprotective agent amifostine protect against cardiac injury, thus allowing the use of higher doses of anthracyclines. Other strategies that have been evaluated are dietary glutamine supplementation and the use of the antioxidant probucol.
Nelson
M A
MA
Department of Medicine, the Albert Einstein College of Medicine, Bronx, New York, USA.
Frishman
W H
WH
Seiter
K
K
Keefe
D
D
Dutcher
J
J
D018943:Anthracyclines / Q000627:therapeutic use* / Q000633:toxicity; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use* / Q000633:toxicity; D002277:Carcinoma / Q000150:complications / Q000188:drug therapy*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002319:Cardiovascular System / Q000187:drug effects*; D004359:Drug Therapy, Combination; D005544:Forecasting; D006331:Heart Diseases / Q000139:chemically induced; D006333:Heart Failure / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008991:Monitoring, Physiologic / Q000592:standards; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D011875:Radionuclide Angiography; D013318:Stroke Volume / Q000187:drug effects; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D018943:Anthracyclines; D000903:Antibiotics, Antineoplastic; D002316:Cardiotonic Agents