Anthracycline-induced cardiotoxicity: course, pathophysiology, prevention and management.
Although effective anti-neoplastic agents, anthracyclines are limited by their well recognized and pervasive cardiotoxic effects. The incidence of late progressive cardiovascular disease in long-term survivors of cancer is established and may contribute to heart failure and death. To maximize the benefits of these drugs, a high-risk population has been identified and new strategies have been investigated to minimize toxic effects, including limiting the cumulative dose, controlling the rate of administration and using liposomal preparations and novel anthracycline analogues. Dexrazoxane also shows promise as a cardioprotectant during treatment. This paper reviews these strategies, as well as medications used to manage anthracycline-induced cardiotoxicity, and functional and biochemical means of monitoring cardiotoxicity, including echocardiography, radionuclide scans and biomarker analysis. The treatment of adult cancer survivors who have had anthracycline-related cardiotoxicity has not been systematically studied. Empirically, anthracycline-associated cardiac dysfunction is treated very similarly to other forms of heart failure. These treatments include avoiding additional cardiotoxic regimens, controlling hypertension, lifestyle changes, medications and heart transplantation.
Barry
Elly
E
Department of Pediatric Oncology, Dana-Farber Cancer Institute/Children's Hospital, Boston/Harvard Medical School, 44 Binney Street, 3rd Floor, Boston, MA 02115, USA.
Alvarez
Jorge A
JA
Scully
Rebecca E
RE
Miller
Tracie L
TL
Lipshultz
Steven E
SE
D018943:Anthracyclines / Q000008:administration & dosage / Q000009:adverse effects*; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects*; D002317:Cardiovascular Agents / Q000627:therapeutic use; D004347:Drug Interactions; D016903:Drug Monitoring / Q000379:methods; D006321:Heart / Q000187:drug effects*; D006331:Heart Diseases / Q000139:chemically induced* / Q000188:drug therapy / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy; D011929:Razoxane / Q000627:therapeutic use; D012307:Risk Factors
D018943:Anthracyclines; D000903:Antibiotics, Antineoplastic; D002317:Cardiovascular Agents; D011929:Razoxane