title: Different anthracycline derivates for reducing cardiotoxicity in cancer patients.
abstract: BACKGROUND
  The use of anthracyclines is limited by the occurrence of cardiotoxicity. In an effort to prevent this cardiotoxicity, different anthracycline derivates have been studied.
  
  
  OBJECTIVE
  To determine the occurrence of cardiotoxicity with the use of different anthracycline derivates in cancer patients.
  
  
  METHODS
  We searched The Cochrane Central Register of Controlled Trials (CENTRAL), (The Cochrane Library, Issue 2, 2009), MEDLINE (1966 to 29 May 2009) and EMBASE (1980 to 2 June 2009). In addition, we searched reference lists of relevant articles, conference proceedings and ongoing-trials-databases.
  
  
  METHODS
  Randomised controlled trials (RCTs) in which different anthracycline derivates were compared in cancer patients (children and adults).
  
  
  METHODS
  Two authors independently performed study selection, assessment of risk of bias and data-extraction including adverse effects.
  
  
  RESULTS
  We identified five RCTs of varying quality addressing epirubicin versus doxorubicin (1036 patients) with the same dose. The meta-analysis showed no evidence for a significant difference in the occurrence of clinical heart failure between the treatment groups (RR = 0.36, 95% CI 0.12 to 1.11). However, there is some suggestion of a lower rate of clinical heart failure in patients treated with epirubicin.We identified two RCTs with varying quality addressing liposomal-encapsulated doxorubicin versus conventional doxorubicin (521 patients). The meta-analysis showed a significantly lower rate of both clinical heart failure and clinical and subclinical heart failure combined in patients treated with liposomal-encapsulated doxorubicin (RR = 0.20, 95% CI 0.05 to 0.75 and RR = 0.38, 95% CI 0.24 to 0.59 respectively). It should be noted that in one of the studies patients in the liposomal-encapsulated doxorubicin group received a higher cumulative anthracycline dose than patients in the doxorubicin group.For the other possible combinations of different anthracycline derivates only one RCT (epirubicin versus liposomal-encapsulated doxorubicin) or no RCT was identified.
  
  
  CONCLUSIONS
  We are not able to favour either epirubicin or doxorubicin when given with the same dose. Based on the currently available evidence on heart failure, we conclude that in adults with a solid tumour liposomal-encapsulated doxorubicin should be favoured over doxorubicin. For both epirubicin versus doxorubicin and liposomal-encapsulated doxorubicin versus conventional doxorubicin no conclusions can be made about the effects of treatment in children treated with anthracyclines and also not in patients diagnosed with leukaemia. More research is needed. For other combinations of anthracycline derivates not enough evidence was available to make definitive conclusions about the occurrence of cardiotoxicity in patients treated with anthracyclines.
authors.affiliation: Paediatric Oncology, Emma Children's Hospital / Academic Medical Center, PO Box 22660 (room F8-257), Amsterdam, Netherlands, 1100 DD.
authors.forename: Elvira C
authors.initials: EC
authors.lastname: van Dalen
authors.forename: Erna Mc
authors.initials: EM
authors.lastname: Michiels
authors.forename: Huib N
authors.initials: HN
authors.lastname: Caron
authors.forename: Leontien Cm
authors.initials: LC
authors.lastname: Kremer
mesh_terms: D000328:Adult; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects*; D002303:Cardiac Output, Low / Q000139:chemically induced; D002648:Child; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects*; D015251:Epirubicin / Q000008:administration & dosage / Q000009:adverse effects*; D006321:Heart / Q000187:drug effects*; D006801:Humans; D008081:Liposomes; D009369:Neoplasms / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic
chemical_list: D000903:Antibiotics, Antineoplastic; D008081:Liposomes; D015251:Epirubicin; D004317:Doxorubicin
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