Cardiotoxicity of cytotoxic drugs.
Cardiotoxicity is a well-known side effect of several cytotoxic drugs, especially of the anthracyclines and can lead to long term morbidity. The mechanism of anthracycline induced cardiotoxicity seems to involve the formation of free radicals leading to oxidative stress. This may cause apoptosis of cardiac cells or immunologic reactions. However, alternative mechanisms may play a role in anthracycline induced cardiotoxicity. Cardiac protection can be achieved by limitation of the cumulative dose. Furthermore, addition of the antioxidant and iron chelator dexrazoxane to anthracycline therapy has shown to be effective in lowering the incidence of anthracycline induced cardiotoxicity. Other cytotoxic drugs such as 5-fluorouracil, cyclophosphamide and the taxoids are associated with cardiotoxicity as well, although little is known about the possible mechanisms. Recently, it appeared that some novel cytotoxic drugs such as trastuzumab and cyclopentenyl cytosine also show cardiotoxic side effects.
Schimmel
Kirsten J M
KJ
Department of Clinical Pharmacy, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Netherlands.
Richel
Dick J
DJ
van den Brink
Renée B A
RB
Guchelaar
Henk-Jan
HJ
D018943:Anthracyclines / Q000009:adverse effects; D000911:Antibodies, Monoclonal / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000975:Antioxidants / Q000627:therapeutic use; D015415:Biomarkers; D015220:Calcium Channels / Q000187:drug effects; D009202:Cardiomyopathies / Q000139:chemically induced / Q000517:prevention & control*; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D002614:Chelating Agents / Q000627:therapeutic use; D002945:Cisplatin / Q000009:adverse effects; D003520:Cyclophosphamide / Q000009:adverse effects; D005472:Fluorouracil / Q000009:adverse effects; D006321:Heart / Q000187:drug effects*; D006801:Humans; D007069:Ifosfamide / Q000009:adverse effects; D018384:Oxidative Stress / Q000187:drug effects; D011929:Razoxane / Q000627:therapeutic use; D012307:Risk Factors; D000068878:Trastuzumab
D018943:Anthracyclines; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000975:Antioxidants; D015415:Biomarkers; D015220:Calcium Channels; D002316:Cardiotonic Agents; D002614:Chelating Agents; D011929:Razoxane; D003520:Cyclophosphamide; D000068878:Trastuzumab; D002945:Cisplatin; D005472:Fluorouracil; D007069:Ifosfamide