Use of cardiac markers to assess the toxic effects of anthracyclines given to children with cancer: a systematic review.
OBJECTIVE
To evaluate the effectiveness of cardiac markers to quantify anthracycline-induced cardiotoxicity in children with cancer.


METHODS
Systematic review using a priori methods.


RESULTS
Seven studies, all with methodological limitations, were identified. One RCT suggests that cardiac troponin can be used to assess the effectiveness of the cardio-protective agent dexrazoxane. Cohort studies suggest that atrial natriuretic peptide and brain (B-type) natriuretic peptide are elevated in some subgroups of patients compared with healthy children; NT-pro-BNP levels are significantly elevated in children with cardiac dysfunction compared with those without; serum lipid peroxide is higher in children who have received doxorubicin compared with children not receiving doxorubicin; there are no differences in carnitine levels between children treated with doxorubicin and a healthy control group.


CONCLUSIONS
The limited evidence makes conclusions difficult. Research is needed to fill this important evidence gap and link short-term changes in cardiac markers to longer-term cardiac damage.
Bryant
J
J
Southampton Health Technology Assessments Centre, Wessex Institute for Health Research and Development, Mailpoint 728, Boldrewood, University of Southampton, Southampton SO16 7PX, United Kingdom. J.S.Bryant@soton.ac.uk
Picot
J
J
Baxter
L
L
Levitt
G
G
Sullivan
I
I
Clegg
A
A
D018943:Anthracyclines / Q000009:adverse effects*; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects*; D015415:Biomarkers / Q000378:metabolism*; D002675:Child, Preschool; D015331:Cohort Studies; D006321:Heart / Q000187:drug effects; D006331:Heart Diseases / Q000139:chemically induced / Q000517:prevention & control*; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D017741:Survivors
D018943:Anthracyclines; D000903:Antibiotics, Antineoplastic; D015415:Biomarkers