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Chemotherapy-induced cardiotoxicity in children.

Abstract With advances in clinical oncology, the burden of morbidity and mortality for cancer survivors due to the cardiac side effects of the chemotherapy is steadily increasing. Treatment-related cardiac damage is progressive and often irreversible. Primary prevention of cardiotoxicity during treatment is possible with strategies like limiting the cumulative anthracycline dose, the use of anthracycline structural analogs, and especially cardioprotective agents. Areas covered: This review covers the various cardiotoxic chemotherapeutic agents, the pathophysiology of cardiotoxicity due to anthracyclines, and the clinical and subclinical presentations and progression of childhood anthracycline cardiotoxicity. We also discuss preventive measures and strategies, especially the cardioprotectant agent dexrazoxane where there is strong evidence-based support for its use with anthracycline chemotherapy. However, there is a paucity of evidence-based recommendations for diagnosing and treating cancer therapy-induced cardiovascular complications. Finally, we discuss the potential of cardio-oncology. Expert opinion: There is no 'safe' anthracycline dose if the goal is normal long-term cardiovascular status but higher lifetime cumulative doses of anthracyclines, higher dose rates, female sex, longer follow-up, younger age at anthracycline treatment, pre-existing cardiovascular disease, and cardiac irradiation are associated with more severe cardiotoxicity. With deeper understanding of the mechanisms of the adverse cardiac effects and identification of driver mutations causing these effects, personalized cancer therapy to limit cardiotoxic effects can be achieved, such as with the cardioprotectant dexrazoxane.
PMID
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Authors

Mayor MeshTerms
Keywords

Childhood cancer

anthracycline

cardio-oncology

cardiotoxicity

survivorship

Journal Title expert opinion on drug metabolism & toxicology
Publication Year Start




PMID- 28679288
OWN - NLM
STAT- MEDLINE
DA  - 20170706
DCOM- 20170807
LR  - 20170807
IS  - 1744-7607 (Electronic)
IS  - 1742-5255 (Linking)
VI  - 13
IP  - 8
DP  - 2017 Aug
TI  - Chemotherapy-induced cardiotoxicity in children.
PG  - 817-832
LID - 10.1080/17425255.2017.1351547 [doi]
AB  - INTRODUCTION: With advances in clinical oncology, the burden of morbidity and
      mortality for cancer survivors due to the cardiac side effects of the
      chemotherapy is steadily increasing. Treatment-related cardiac damage is
      progressive and often irreversible. Primary prevention of cardiotoxicity during
      treatment is possible with strategies like limiting the cumulative anthracycline 
      dose, the use of anthracycline structural analogs, and especially
      cardioprotective agents. Areas covered: This review covers the various
      cardiotoxic chemotherapeutic agents, the pathophysiology of cardiotoxicity due to
      anthracyclines, and the clinical and subclinical presentations and progression of
      childhood anthracycline cardiotoxicity. We also discuss preventive measures and
      strategies, especially the cardioprotectant agent dexrazoxane where there is
      strong evidence-based support for its use with anthracycline chemotherapy.
      However, there is a paucity of evidence-based recommendations for diagnosing and 
      treating cancer therapy-induced cardiovascular complications. Finally, we discuss
      the potential of cardio-oncology. Expert opinion: There is no 'safe'
      anthracycline dose if the goal is normal long-term cardiovascular status but
      higher lifetime cumulative doses of anthracyclines, higher dose rates, female
      sex, longer follow-up, younger age at anthracycline treatment, pre-existing
      cardiovascular disease, and cardiac irradiation are associated with more severe
      cardiotoxicity. With deeper understanding of the mechanisms of the adverse
      cardiac effects and identification of driver mutations causing these effects,
      personalized cancer therapy to limit cardiotoxic effects can be achieved, such as
      with the cardioprotectant dexrazoxane.
FAU - Bansal, Neha
AU  - Bansal N
AD  - a Department of Pediatrics , Wayne State University School of Medicine and
      Children's Hospital of Michigan , Detroit , MI , USA.
FAU - Amdani, Shahnawaz
AU  - Amdani S
AD  - a Department of Pediatrics , Wayne State University School of Medicine and
      Children's Hospital of Michigan , Detroit , MI , USA.
FAU - Lipshultz, Emma R
AU  - Lipshultz ER
AD  - c Department of Pediatric Oncology , Dana-Farber Cancer Institute , Boston , MA ,
      USA.
FAU - Lipshultz, Steven E
AU  - Lipshultz SE
AD  - a Department of Pediatrics , Wayne State University School of Medicine and
      Children's Hospital of Michigan , Detroit , MI , USA.
AD  - b Karmanos Cancer Institute , Detroit , MI , USA.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20170713
PL  - England
TA  - Expert Opin Drug Metab Toxicol
JT  - Expert opinion on drug metabolism & toxicology
JID - 101228422
RN  - 0 (Anthracyclines)
RN  - 0 (Antineoplastic Agents)
RN  - 0 (Cardiotonic Agents)
RN  - 048L81261F (Dexrazoxane)
SB  - IM
MH  - Animals
MH  - Anthracyclines/administration & dosage/*adverse effects
MH  - Antineoplastic Agents/administration & dosage/*adverse effects
MH  - Cardiotonic Agents/therapeutic use
MH  - Cardiotoxicity/*etiology/prevention & control
MH  - Child
MH  - Dexrazoxane/therapeutic use
MH  - Dose-Response Relationship, Drug
MH  - Female
MH  - Humans
MH  - Male
MH  - Neoplasms/drug therapy
MH  - Primary Prevention/methods
MH  - Risk Factors
OTO - NOTNLM
OT  - Childhood cancer
OT  - anthracycline
OT  - cardio-oncology
OT  - cardiotoxicity
OT  - survivorship
EDAT- 2017/07/07 06:00
MHDA- 2017/08/08 06:00
CRDT- 2017/07/07 06:00
AID - 10.1080/17425255.2017.1351547 [doi]
PST - ppublish
SO  - Expert Opin Drug Metab Toxicol. 2017 Aug;13(8):817-832. doi:
      10.1080/17425255.2017.1351547. Epub 2017 Jul 13.