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2015 | 5 | 4 | A169-176
Article title

Early diagnostics and prevention of anthracycline-induced cardiomyopathy – the role of cardiologist

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Anticancer antibiotics, anthracyclines, may cause severe left ventricle systolic dysfunction that is associated with poor clinical prognosis. In this review, we discuss the mechanisms and risk factors of anthracycline-induced cardiotoxicity and cardiomyopathy, among which the cumulative administered dose of anthracyclines and concurrent cardiovascular diseases are the most important. We also present strategies for primary and secondary prevention of anthracycline-induced cardiotoxicity via rigorous assessment of early signs of left ventricular dysfunction.

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  • Russian Cardiology Research and Production Complex, Russia
  • Russian Cardiology Research and Production Complex, Russia
  • Russian Cardiology Research and Production Complex, Russia
  • 1. Cancer statistic in the US 1990–2008: data from the National Cancer Institute on estimated number of cancer survivors and age-adjusted cancer deaths per 100,000 people.
  • 2. Armstrong G, Liu Q, Yasui Y et al. Late mortality among 5-year survivors of childhood cancer: a summary from the Childhood Cancer Survivor Study. J Clin Oncol 2009; 27: 2328-2338.
  • 3. Yeh, Tong A, Lenihan D et al. Cardiovascular complications of cancer therapy: diagnosis, pathogenesis, and management. Circulation 2004; 109: 3122-3131.
  • 4. Ewer M, Lippman S. Type II chemotherapy-related cardiac dysfunction: time to recognize a new entity. J Clin Oncol 2005; 23: 2900-2902.
  • 5. Felker G, Thompson R, Hare J et al. Underlying causes and long-term survival in patients with initially unexplained cardiomyopathy. N Engl J Med 2000; 342: 1077-1084.
  • 6. Plana J, Galderisi M, Barac A et al. Expert consensus for multimodality imaging evaluation of adult cancer patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2014; 27: 911-939.
  • 7. Ewer M, Ewer S. Cardiotoxicity of anticancer treatments: what the cardiologist needs to know. Nat Rev Cardiol 2010; 7: 564-575.
  • 8. Chen M, Colan S, Diller L. Cardiovascular disease: cause of morbidity and mortality in adult survivors of childhood cancers. Circ Res 2011; 108: 619-628.
  • 9. Sawyer D, Lenihan D. Managing heart failure in cancer patients. In: Mann D, Felker G. Heart Failure: A Companion to Braunwald’s Heart Disease, 3rd ed. Elsevier, Philadelphia 2016: 689-696.
  • 10. Ganame J, Claus P, Eyskens B et al. Acute cardiac functional and morphological changes after Anthracycline infusions in children. Am J Cardiol 2007; 99: 974-977.
  • 11. Cardinale D, Colombo A, Bacchiani G et al. Early detection of anthracycline-cardiotoxicity and improvement with heart failure therapy. Circulation 2015; 22: 1981-1988.
  • 12. Ryberg M, Nielsen D, Skovsgaard T et al. Epirubicin-cardiotoxicity: an analysis of 469 patients with metastatic breast cancer. J Clin Oncol 1998; 16: 3502-3508.
  • 13. Nielsen D, Jensen J, Dombernowsky P et al. Epirubicin-cardiotoxicity: a study of 135 patients with advanced breast cancer. J Clin Oncol 1990; 8: 1806-1810.
  • 14. Jones R, Swanton C, Ewer M et al. Anthracycline cardiotoxicity. Expert Opin Drug Saf 2006; 5: 791-809.
  • 15. Blanco J, Sun C, Landier W et al. Anthracycline-related cardiomyopathy after childhood cancer: role of polymorphisms in carbonyl reductase genes – a report from the Children’s Oncology Group. J Clin Oncol 2012; 30: 1415-1421.
  • 16. Van der Pal H, van Dalen E, van Delden E et al. High risk of symptomatic cardiac events in childhood cancer survivors. J Clin Oncol 2012; 30: 1429- -1437.
  • 17. Tan-Chiu E, Yothers G, Romond E et al. Assessment of cardiac dysfunction in a randomized trial comparing doxorubicin and cyclophosphamide followed by paclitaxel, with or without trastuzumab as adjuvant therapy in node-positive, human epidermal growth factor receptor 2-overexpressing breast cancer: NSABP B-31. J Clin Oncol 2005; 23: 7811-7819.
  • 18. Lang R, Badano L, Mor-Avi V et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015; 28: 1-39.
  • 19. Nagueh S, Appleton C, Gillebert T et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 2009; 22: 107-133.
  • 20. Swain S, Whaley F, Ewer M. Congestive heart failure in patients treated with doxorubicin: a retrospective analysis of three trials. Cancer 2003; 97: 2869-2879.
  • 21. Owens M, Horten B, Da Silva M et al. HER2 amplification ratios by fluorescence in situ hybridization and correlation with immunohistochemistry in a cohort of 6556 breast cancer tissues. Clin Breast Cancer 2004; 5: 63-69.
  • 22. Romond E, Perez E, Bryant J et al. Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. N Engl J Med 2005; 353: 1673-1684.
  • 23. Piccart-Gebhart M, Procter M, Leyland-Jones B et al. Herceptin Adjuvant (HERA) Trial Study Team. Trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer. N Engl J Med 2005; 353: 1659-1672.
  • 24. Joensuu H, Bono P, Kataja V et al. Fluorouracil, epirubicin, and cyclophosphamide with either docetaxel or vinorelbine, with or without trastuzumab, as adjuvant treatments of breast cancer: final results of the FinHer Trial. J Clin Oncol 2009; 27: 5685-5692.
  • 25. Seidman A, Hudis C, Pierri M et al. Cardiac dysfunction in the trastuzumab clinical trials experience. J Clin Oncol 2002; 20: 1215-1221.
  • 26. Armstrong G, Plana J, Zhang N et al. Screening adult survivors of childhood cancer for cardiomyopathy: comparison of echocardiography and cardiac magnetic resonance imaging. J Clin Oncol 2012; 30: 2876-2884.
  • 27. Albini A, Pennesi G, Donatelli F et al. Cardiotoxicity of anticancer drugs: the need for cardio-oncology and cardio-oncological prevention. J Natl Cancer Inst 2010; 102: 14-25.
  • 28. Negishi K, Negishi T, Hare J et al. Independent and incremental value of deformation indices for prediction of trastuzumab-induced cardiotoxicity. J Am Soc Echocardiogr 2013; 26: 493-498.
  • 29. Thavendiranathan P, Poulin F, Lim K et al. Use of myocardial strain imaging by echocardiography for the early detection of cardiotoxicity in patients during and after cancer chemotherapy: a systematic review. J Am CollCardiol 2014; 63(25 PtA): 2751-2768.
  • 30. Mor-Avi V, Lang R, Badano L et al. Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/ EAE Consensus Statement on Methodology and Indications Endorsed by the Japanese Society of Echocardiography. J Am Soc Echocardiogr 2011; 24: 277-313.
  • 31. Cardinale D, Sandri M, Colombo A et al. Prognostic value of troponin I in cardiac risk stratification of cancer patients undergoing high-dose chemotherapy. Circulation 2004; 109: 2749-2754.
  • 32. Cardinale D, Colombo A, Torrisi R et al. Trastuzumab-induced cardiotoxicity: clinical and prognostic implications of troponin I evaluation. J Clin Oncol 2010; 28: 3910-3916.
  • 33. Sawaya H, Sebag I, Plana J et al. Early detection and prediction of cardiotoxicity in chemotherapy-treated patients. Am J Cardiol 2011; 107: 1375- -1380.
  • 34. Herrmann J, Lerman A, Sandhu N et al. Evaluation and management of patients with heart disease and cancer: Cardio-Oncology. Mayo Clin Proc 2014; 89: 1287-1306.
  • 35. Schwartz R, McKenzie W, Alexander J et al. Congestive heart failure and left ventricular dysfunction complicating doxorubicin therapy: seven-year
  • experience using serial radionuclide angiocardiography. Am J Med 1987; 82: 1109-1118.
  • 36. Valdivieso M, Burgess MA, Ewer MS et al. Increased therapeutic index of weekly doxorubicin in the therapy of non-small cell lung cancer: a prospective, randomized study. J Clin Oncol 1984; 2: 207-214.
  • 37. Legha S, Benjamin R, Mackay B et al. Reduction of doxorubicin cardiotoxicity by prolonged continuous intravenous infusion. Ann Intern Med 1982; 96: 133-139.
  • 38. Vejpongsa P, Yeh E. Prevention of anthracycline-induced cardiotoxicity: challenges and opportunities. J Am Coll Cardiol 2014; 64: 938-945.
  • 39. Van Dalen E, Caron HN, Dickinson HO, Kremer LC. Cardioprotective interventions for cancer patients receiving anthracyclines. Cochrane Database Syst Rev 2011; (6): CD003917.
  • 40. Orditura M, Quaglia F, Morgillo F et al. Pegylated liposomal doxorubicin: pharmacologic and clinical evidence of potent antitumor activity with reduced anthracycline-induced cardiotoxicity (review). Oncology Reports 2004; 12: 549-556.
  • 41. O’Shaughnessy J. Pegylated Liposomal Doxorubicin in the Treatment of Breast Cancer. Clin Breast Cancer 2003; 4: 318-328.
  • 42. O’Brien M, Wigler N, Inbar M et al. Reduced cardiotoxicity and comparable efficacy in a phase III trial of pegylated liposomal doxorubicin HCl (CAELYX/Doxil) versus conventional doxorubicin for first-line treatment of metastatic breast cancer. Ann Oncol 2004; 15: 440-449.
  • 43. Cardinale D, Colombo A, Sandri M et al. Prevention of high-dose chemotherapy-induced cardiotoxicity in high-risk patients by angiotensin-converting enzyme inhibition. Circulation 2006; 114: 2474-2481.
  • 44. Kalay N, Basar E, Ozdogru I et al. Protective effects of carvedilol against anthracycline-induced cardiomyopathy. J Am Coll Cardiol 2006; 48: 2258- -2262.
  • 45. Georgakopoulos P, Roussou P, Matsakas E et al. Cardioprotective effect of metoprolol and enalapril in doxorubicin-treated lymphoma patients: a prospective, parallel-group, randomized, controlled study with 36-month follow-up. Am J Hematol 2010; 85: 894-896.
  • 46. Cardinale D, Colombo A, Lamantia G et al. Anthracycline-induced cardiomyopathy: clinical relevance and response to pharmacologic therapy. J Am Coll Cardiol 2010; 55: 213-220.
  • 47. Lipshultz S, Lipsitz S, Sallan S et al. Long-term enalapril therapy for left ventricular dysfunction in doxorubicin-treated survivors of childhood cancer. J Clin Oncol 2002; 20: 4517-4722.
  • 48. Bosch X, Rovira M, Sitges M et al. Enalapril and carvedilol for preventing chemotherapy-induced left ventricular systolic dysfunction in patients with malignant hemopathies. J Am Coll Cardiol 2013; 61: 2355-2362.
  • 49. Tallaj JA, Franco V, Rayburn B et al. Response of doxorubicin-induced cardiomyopathy to the current management strategy of heart failure. J Heart Lung Transplant 2005; 24: 2196-2201.
  • 50. Jensen B, Skovsgaard T, Nielsen S. Functional monitoring of anthracycline cardiotoxicity: a prospective, blinded, long-term observational study of outcome in 120 patients. Ann Oncol 2002; 13: 699-709.
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