Document Detail


Cardiotoxicity of cancer chemotherapy: implications for children.
MedLine Citation:
PMID:  15977964     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Many children and adolescents with cancer receive chemotherapeutic agents that are cardiotoxic. Thus, while survival rates in this population have improved for some cancers, many survivors may experience acute or chronic cardiovascular complications that can impair their quality of life years after treatment. In addition, cardiac complications of treatment lead to reductions in dose and duration of chemotherapy regimens, potentially compromising clinical efficacy. Anthracyclines are well known for their cardiotoxicity, and alkylating agents, such as cyclophosphamide, ifosfamide, cisplatin, busulfan, and mitomycin, have also been associated with cardiotoxicity. Other agents with cardiac effects include vinca alkaloids, fluorouracil, cytarabine, amsacrine, and asparaginase and the newer agents, paclitaxel, trastuzumab, etoposide, and teniposide. The heart is relatively vulnerable to oxidative injuries from oxygen radicals generated by chemotherapy. The cardiac effects of these drugs include asymptomatic electrocardiographic abnormalities, blood pressure changes, arrhythmias, myocarditis, pericarditis, cardiac tamponade, acute myocardial infarction, cardiac failure, shock, and long-term cardiomyopathy. These effects may occur during or immediately after treatment or may not be apparent until months or years after treatment. Mild myocardiocyte injury from chemotherapy may be of more concern in children than in adults because of the need for subsequent cardiac growth to match somatic growth and because survival is longer in children. Primary prevention is therefore important. Patients should be educated about the cardiotoxic risks of treatment and the need for long-term cardiac monitoring before chemotherapy is begun. Cardiotoxicity may be prevented by screening for risk factors, monitoring for signs and symptoms during chemotherapy, and continuing follow-up that may include electrocardiographic and echocardiographic studies, angiography, and measurements of biochemical markers of myocardial injury. Secondary prevention should aim to minimize progression of left ventricular dysfunction to overt heart failure. Approaches include altering the dose, schedule, or approach to drug delivery; using analogs or new formulations with fewer or milder cardiotoxic effects; using cardioprotectants and agents that reduce oxidative stress during chemotherapy; correcting for metabolic derangements caused by chemotherapy that can potentiate the cardiotoxic effects of the drug; and cardiac monitoring during and after cancer therapy. Avoiding additional cardiotoxic regimens is also important in managing these patients. Treating the adverse cardiac effects of chemotherapy will usually be dependent on symptoms or will depend on the anticipated cardiovascular effects of each regimen. Treatments include diuresis, afterload reduction, beta-adrenoceptor antagonists, and improving myocardial contractility.
Authors:
Valeriano C Simbre; Sarah A Duffy; Gul H Dadlani; Tracie L Miller; Steven E Lipshultz
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.; Review    
Journal Detail:
Title:  Paediatric drugs     Volume:  7     ISSN:  1174-5878     ISO Abbreviation:  Paediatr Drugs     Publication Date:  2005  
Date Detail:
Created Date:  2005-06-27     Completed Date:  2005-10-19     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  100883685     Medline TA:  Paediatr Drugs     Country:  New Zealand    
Other Details:
Languages:  eng     Pagination:  187-202     Citation Subset:  IM    
Affiliation:
Division of Pediatric Cardiology, University of Rochester Medical Center and Golisano Children's Hospital at Strong, Rochester, New York, USA.
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MeSH Terms
Descriptor/Qualifier:
Anthracyclines / adverse effects
Antineoplastic Agents / adverse effects*,  therapeutic use
Child
Heart Diseases / chemically induced*
Humans
Neoplasms / complications*,  drug therapy
Grant Support
ID/Acronym/Agency:
CA-79060/CA/NCI NIH HHS; CA68484/CA/NCI NIH HHS; HL53392/HL/NHLBI NIH HHS; HL59837/HL/NHLBI NIH HHS; HL72705/HL/NHLBI NIH HHS; HL78522/HL/NHLBI NIH HHS; HR96041/HR/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Anthracyclines; 0/Antineoplastic Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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