Anthracycline-associated cardiotoxicity in survivors of childhood cancer

Barry H. Trachtenberg, David C. Landy, Vivian I. Franco, Jacqueline M. Henkel, Elliot J. Pearson, Tracie L Miller, Steven E Lipshultz

Research output: Contribution to journalArticle

103 Citations (Scopus)

Abstract

Anthracycline chemotherapeutic agents are widely used to treat childhood cancers, helping to create an increasing population of childhood cancer survivors. Cardiac complications can occur years after exposure to anthracyclines and are a leading cause of noncancerous morbidity and mortality in this population. The mechanism of its cardiotoxicity is not completely known, although oxidative stress is believed to play a significant role. This pathway and other nonoxidative mechanisms are reviewed. Several risk factors such as age, dose, female gender, and concomitant radiation therapy are known, but the relative risks of many comorbidities such as diabetes and hypertension are not well studied. No standard, evidence-based guidelines for appropriate screening methods to detect cardiotoxicity exist. Periodic imaging with echocardiography or radionuclide angiography is appropriately recommended for long-term survivors but is of limited use during therapy. Biomarkers such as cardiac troponins and brain natriuretic peptides may aid in detecting cardiotoxicity. Studies investigating the use of agents such as angiotensin-converting enzyme (ACE)-inhibitors and beta-blockers to treat anthracycline cardiotoxicity have shown promise, but more data are needed. Structural analogs such as epirubicin were developed to minimize cardiotoxicity but have not sufficiently reduced it. Liposome-encapsulated anthracyclines have shown a considerable decrease of cardiotoxicity in adults without sacrificing efficacy, but the data related to children are sparse. The only agent proven to be cardioprotective is the iron chelator, dexrazoxane. Studies have shown that dexrazoxane is safe and significantly reduces the incidence of cardiotoxicity. Dexrazoxane should be considered for pediatric oncology protocols using anthracyclines that include longitudinal assessment.

Original languageEnglish
Pages (from-to)342-353
Number of pages12
JournalPediatric Cardiology
Volume32
Issue number3
DOIs
StatePublished - Mar 1 2011

Fingerprint

Anthracyclines
Survivors
Dexrazoxane
Neoplasms
Radionuclide Angiography
Epirubicin
Troponin
Brain Natriuretic Peptide
Chelating Agents
Cardiotoxicity
Angiotensin-Converting Enzyme Inhibitors
Liposomes
Population
Echocardiography
Comorbidity
Oxidative Stress
Radiotherapy
Iron
Biomarkers
Guidelines

Keywords

  • Anthracyclines
  • Cardiotoxicity
  • Dexrazoxane

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pediatrics, Perinatology, and Child Health

Cite this

Trachtenberg, B. H., Landy, D. C., Franco, V. I., Henkel, J. M., Pearson, E. J., Miller, T. L., & Lipshultz, S. E. (2011). Anthracycline-associated cardiotoxicity in survivors of childhood cancer. Pediatric Cardiology, 32(3), 342-353. https://doi.org/10.1007/s00246-010-9878-3

Anthracycline-associated cardiotoxicity in survivors of childhood cancer. / Trachtenberg, Barry H.; Landy, David C.; Franco, Vivian I.; Henkel, Jacqueline M.; Pearson, Elliot J.; Miller, Tracie L; Lipshultz, Steven E.

In: Pediatric Cardiology, Vol. 32, No. 3, 01.03.2011, p. 342-353.

Research output: Contribution to journalArticle

Trachtenberg, BH, Landy, DC, Franco, VI, Henkel, JM, Pearson, EJ, Miller, TL & Lipshultz, SE 2011, 'Anthracycline-associated cardiotoxicity in survivors of childhood cancer', Pediatric Cardiology, vol. 32, no. 3, pp. 342-353. https://doi.org/10.1007/s00246-010-9878-3
Trachtenberg BH, Landy DC, Franco VI, Henkel JM, Pearson EJ, Miller TL et al. Anthracycline-associated cardiotoxicity in survivors of childhood cancer. Pediatric Cardiology. 2011 Mar 1;32(3):342-353. https://doi.org/10.1007/s00246-010-9878-3
Trachtenberg, Barry H. ; Landy, David C. ; Franco, Vivian I. ; Henkel, Jacqueline M. ; Pearson, Elliot J. ; Miller, Tracie L ; Lipshultz, Steven E. / Anthracycline-associated cardiotoxicity in survivors of childhood cancer. In: Pediatric Cardiology. 2011 ; Vol. 32, No. 3. pp. 342-353.
@article{167e313a5d7e426c832fc12417f0a7bd,
title = "Anthracycline-associated cardiotoxicity in survivors of childhood cancer",
abstract = "Anthracycline chemotherapeutic agents are widely used to treat childhood cancers, helping to create an increasing population of childhood cancer survivors. Cardiac complications can occur years after exposure to anthracyclines and are a leading cause of noncancerous morbidity and mortality in this population. The mechanism of its cardiotoxicity is not completely known, although oxidative stress is believed to play a significant role. This pathway and other nonoxidative mechanisms are reviewed. Several risk factors such as age, dose, female gender, and concomitant radiation therapy are known, but the relative risks of many comorbidities such as diabetes and hypertension are not well studied. No standard, evidence-based guidelines for appropriate screening methods to detect cardiotoxicity exist. Periodic imaging with echocardiography or radionuclide angiography is appropriately recommended for long-term survivors but is of limited use during therapy. Biomarkers such as cardiac troponins and brain natriuretic peptides may aid in detecting cardiotoxicity. Studies investigating the use of agents such as angiotensin-converting enzyme (ACE)-inhibitors and beta-blockers to treat anthracycline cardiotoxicity have shown promise, but more data are needed. Structural analogs such as epirubicin were developed to minimize cardiotoxicity but have not sufficiently reduced it. Liposome-encapsulated anthracyclines have shown a considerable decrease of cardiotoxicity in adults without sacrificing efficacy, but the data related to children are sparse. The only agent proven to be cardioprotective is the iron chelator, dexrazoxane. Studies have shown that dexrazoxane is safe and significantly reduces the incidence of cardiotoxicity. Dexrazoxane should be considered for pediatric oncology protocols using anthracyclines that include longitudinal assessment.",
keywords = "Anthracyclines, Cardiotoxicity, Dexrazoxane",
author = "Trachtenberg, {Barry H.} and Landy, {David C.} and Franco, {Vivian I.} and Henkel, {Jacqueline M.} and Pearson, {Elliot J.} and Miller, {Tracie L} and Lipshultz, {Steven E}",
year = "2011",
month = "3",
day = "1",
doi = "10.1007/s00246-010-9878-3",
language = "English",
volume = "32",
pages = "342--353",
journal = "Pediatric Cardiology",
issn = "0172-0643",
publisher = "Springer New York",
number = "3",

}

TY - JOUR

T1 - Anthracycline-associated cardiotoxicity in survivors of childhood cancer

AU - Trachtenberg, Barry H.

AU - Landy, David C.

AU - Franco, Vivian I.

AU - Henkel, Jacqueline M.

AU - Pearson, Elliot J.

AU - Miller, Tracie L

AU - Lipshultz, Steven E

PY - 2011/3/1

Y1 - 2011/3/1

N2 - Anthracycline chemotherapeutic agents are widely used to treat childhood cancers, helping to create an increasing population of childhood cancer survivors. Cardiac complications can occur years after exposure to anthracyclines and are a leading cause of noncancerous morbidity and mortality in this population. The mechanism of its cardiotoxicity is not completely known, although oxidative stress is believed to play a significant role. This pathway and other nonoxidative mechanisms are reviewed. Several risk factors such as age, dose, female gender, and concomitant radiation therapy are known, but the relative risks of many comorbidities such as diabetes and hypertension are not well studied. No standard, evidence-based guidelines for appropriate screening methods to detect cardiotoxicity exist. Periodic imaging with echocardiography or radionuclide angiography is appropriately recommended for long-term survivors but is of limited use during therapy. Biomarkers such as cardiac troponins and brain natriuretic peptides may aid in detecting cardiotoxicity. Studies investigating the use of agents such as angiotensin-converting enzyme (ACE)-inhibitors and beta-blockers to treat anthracycline cardiotoxicity have shown promise, but more data are needed. Structural analogs such as epirubicin were developed to minimize cardiotoxicity but have not sufficiently reduced it. Liposome-encapsulated anthracyclines have shown a considerable decrease of cardiotoxicity in adults without sacrificing efficacy, but the data related to children are sparse. The only agent proven to be cardioprotective is the iron chelator, dexrazoxane. Studies have shown that dexrazoxane is safe and significantly reduces the incidence of cardiotoxicity. Dexrazoxane should be considered for pediatric oncology protocols using anthracyclines that include longitudinal assessment.

AB - Anthracycline chemotherapeutic agents are widely used to treat childhood cancers, helping to create an increasing population of childhood cancer survivors. Cardiac complications can occur years after exposure to anthracyclines and are a leading cause of noncancerous morbidity and mortality in this population. The mechanism of its cardiotoxicity is not completely known, although oxidative stress is believed to play a significant role. This pathway and other nonoxidative mechanisms are reviewed. Several risk factors such as age, dose, female gender, and concomitant radiation therapy are known, but the relative risks of many comorbidities such as diabetes and hypertension are not well studied. No standard, evidence-based guidelines for appropriate screening methods to detect cardiotoxicity exist. Periodic imaging with echocardiography or radionuclide angiography is appropriately recommended for long-term survivors but is of limited use during therapy. Biomarkers such as cardiac troponins and brain natriuretic peptides may aid in detecting cardiotoxicity. Studies investigating the use of agents such as angiotensin-converting enzyme (ACE)-inhibitors and beta-blockers to treat anthracycline cardiotoxicity have shown promise, but more data are needed. Structural analogs such as epirubicin were developed to minimize cardiotoxicity but have not sufficiently reduced it. Liposome-encapsulated anthracyclines have shown a considerable decrease of cardiotoxicity in adults without sacrificing efficacy, but the data related to children are sparse. The only agent proven to be cardioprotective is the iron chelator, dexrazoxane. Studies have shown that dexrazoxane is safe and significantly reduces the incidence of cardiotoxicity. Dexrazoxane should be considered for pediatric oncology protocols using anthracyclines that include longitudinal assessment.

KW - Anthracyclines

KW - Cardiotoxicity

KW - Dexrazoxane

UR - http://www.scopus.com/inward/record.url?scp=79953732943&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79953732943&partnerID=8YFLogxK

U2 - 10.1007/s00246-010-9878-3

DO - 10.1007/s00246-010-9878-3

M3 - Article

VL - 32

SP - 342

EP - 353

JO - Pediatric Cardiology

JF - Pediatric Cardiology

SN - 0172-0643

IS - 3

ER -