title: Maximizing anthracycline tolerability in hematologic malignancies: Treat to each heart's content.
abstract: Anthracyclines are the cornerstone of therapy for a wide spectrum of malignancies and have improved patient survival. Concern for anthracycline-related cardiotoxicity often leads to dose reductions or use of second-line regimens, which may adversely impact survival. Development of cardiotoxicity depends on a combination of cumulative dose modulated by individual patient characteristics, which we have termed individual cardiotoxic threshold (ICT). Patients with cancer often have characteristics such as age, gender, genetic predisposition and preexisting cardiovascular disease that can potentiate cardiotoxicity. Specialty cardiovascular assessment, more sensitive monitoring technology, and timely interventions in selected patients can decrease cardiotoxicity and improve patient outcomes. Prophylaxis with cardioprotective agents and other strategies have shown promising results in randomized trials and may improve tolerance to anthracyclines. In this review we introduce the concept of ICT and critically analyze the evidence supporting existing strategies to modulate it and increase cardiovascular tolerability of anthracyclines.
authors.affiliation: Onco-cardiology Program, Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH, USA; University Hospitals Seidman Cancer Center, Cleveland, OH, USA; Department of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA. Electronic address: guilherme.oliveira@uhhospitals.org.
authors.forename: Guilherme H
authors.initials: GH
authors.lastname: Oliveira
authors.affiliation: Onco-cardiology Program, Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH, USA; Department of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Sadeer G
authors.initials: SG
authors.lastname: Al-Kindi
authors.affiliation: University Hospitals Seidman Cancer Center, Cleveland, OH, USA; Department of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Paolo F
authors.initials: PF
authors.lastname: Caimi
authors.affiliation: University Hospitals Seidman Cancer Center, Cleveland, OH, USA; Department of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
mesh_terms: D018943:Anthracyclines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D066126:Cardiotoxicity; D018890:Chemoprevention; D015897:Comorbidity; D004361:Drug Tolerance; D006331:Heart Diseases / Q000453:epidemiology / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D019337:Hematologic Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D015995:Prevalence; D012307:Risk Factors
chemical_list: D018943:Anthracyclines; D000970:Antineoplastic Agents
keywords: Anthracyclines; Assessment; Cardiomyopathy; Cardiotoxicity; Daunorubicin; Doxorubicin; Prophylaxis; Screening; Tolerance