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Sun S, Qin J, Liao W, Gao X, Shang Z, Luo D, Xiong S. Mitochondrial Dysfunction in Cardiotoxicity Induced by BCR-ABL1 Tyrosine Kinase Inhibitors -Underlying Mechanisms, Detection, Potential Therapies. Cardiovasc Toxicol 2023; 23:233-254. [PMID: 37479951 DOI: 10.1007/s12012-023-09800-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/08/2023] [Indexed: 07/23/2023]
Abstract
The advent of BCR-ABL tyrosine kinase inhibitors (TKIs) targeted therapy revolutionized the treatment of chronic myeloid leukemia (CML) patients. Mitochondria are the key organelles for the maintenance of myocardial tissue homeostasis. However, cardiotoxicity associated with BCR-ABL1 TKIs can directly or indirectly cause mitochondrial damage and dysfunction, playing a pivotal role in cardiomyocytes homeostatic system and putting the cancer survivors at higher risk. In this review, we summarize the cardiotoxicity caused by BCR-ABL1 TKIs and the underlying mechanisms, which contribute dominantly to the damage of mitochondrial structure and dysfunction: endoplasmic reticulum (ER) stress, mitochondrial stress, damage of myocardial cell mitochondrial respiratory chain, increased production of mitochondrial reactive oxygen species (ROS), and other kinases and other potential mechanisms of cardiotoxicity induced by BCR-ABL1 TKIs. Furthermore, detection and management of BCR-ABL1 TKIs will promote our rational use, and cardioprotection strategies based on mitochondria will improve our understanding of the cardiotoxicity from a mitochondrial perspective. Ultimately, we hope shed light on clinical decision-making. By integrate and learn from both research and practice, we will endeavor to minimize the mitochondria-mediated cardiotoxicity and reduce the adverse sequelae associated with BCR-ABL1 TKIs.
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Affiliation(s)
- Sheng Sun
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Department of Medical Oncology, Hospital of Chengdu University of Traditioanal Chinese Medicine, Chengdu, 610075, Sichuan Province, China
| | - Jiqiu Qin
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wenhao Liao
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiang Gao
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhoubiao Shang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Dehua Luo
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shaoquan Xiong
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
- Department of Medical Oncology, Hospital of Chengdu University of Traditioanal Chinese Medicine, Chengdu, 610075, Sichuan Province, China.
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2
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Moustafa I, Viljoen M, Perumal-Pillay VA, Oosthuizen F. Critical appraisal of clinical guidelines for prevention and management of doxorubicin-induced cardiotoxicity. J Oncol Pharm Pract 2022; 29:695-708. [PMID: 36567532 DOI: 10.1177/10781552221147660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Doxorubicin is a valuable chemotherapeutic drug; however, it is associated with a high risk of cardiotoxicity. Several institutions and organizations have developed guidelines for risk factor assessment, monitoring and prevention strategies against chemotherapy-induced cardiotoxicity. This review aimed to assess the quality of current practice guidelines, using the Appraisal of Guidelines for Research and Evaluation II (AGREE II). This tool was used to compare the recommendations with regards to their strength and evidence recommendations were based on. DATA SOURCES This review identified guidelines in literature from January 1960 to February 6, 2022, through a systematic search that included PubMed, EMBASE, MEDLINE, Cochrane Database and Google Scholar. The quality, consistency and the strength of supporting evidence was evaluated using the AGREE II method. DATA SUMMARY Eight guidelines met the inclusion criteria and 144 recommendations were extracted from these guidelines. The results from the AGREE II evaluation showed that the total assessment scores of guidelines ranged from 2 to 5, indicating the guidelines need modifications. The recommendations were evaluated according to the references used, and it was found that 12 (11%) recommendations had high evidence, 36 (33%) had moderate evidence, 38 (35.19%) had low and 22 (20.37%) had insufficient evidence. Recommendations for risk factors assessment, prophylaxis of cardiotoxicity, management of cardiotoxicity and monitoring of cardiotoxicity were quite varied amongst the different guidelines evaluated. CONCLUSIONS All studied guidelines need modifications as per the AGREE II evaluating tool. Several shortcomings were identified, including a lack of evidence-based studies supporting the recommendations in the guidelines.
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Affiliation(s)
- Iman Moustafa
- Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,Pharmaceutical care department, King Abdulaziz Hospital, Ministry of the National Guard - Health Affairs, AlHasa, Saudi Arabia.,King Abdullah International Medical Research Center, AlHasa, Saudi Arabia
| | - Michelle Viljoen
- School of Pharmacy, 56390University of the Western Cape, Bellville, South Africa
| | - Velisha Ann Perumal-Pillay
- Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Frasia Oosthuizen
- Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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3
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Postigo-Martin P, Peñafiel-Burkhardt R, Gallart-Aragón T, Alcaide-Lucena M, Artacho-Cordón F, Galiano-Castillo N, Fernández-Lao C, Martín-Martín L, Lozano-Lozano M, Ruíz-Vozmediano J, Moreno-Gutiérrez S, Illescas-Montes R, Arroyo-Morales M, Cantarero-Villanueva I. Attenuating Treatment-Related Cardiotoxicity in Women Recently Diagnosed With Breast Cancer via a Tailored Therapeutic Exercise Program: Protocol of the ATOPE Trial. Phys Ther 2021; 101:6124131. [PMID: 33528004 DOI: 10.1093/ptj/pzab014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/09/2020] [Accepted: 12/01/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Therapeutic exercise is already used to ameliorate some of the side effects of cancer treatment. Recent studies examined its preventive potential regarding treatment-related toxicity, which can increase the risk of functional decline and lead to disease recurrence and death. This trial will examine whether the Tailored Therapeutic Exercise and Recovery Strategies (ATOPE) program, performed before treatment, can mitigate the onset and extent of cardiotoxicity beyond that achieved when the program is followed during treatment in recently diagnosed breast cancer patients. METHODS The intervention has a preparatory phase plus 12 to 18 sessions of tailored, high-intensity exercise, and post-exercise recovery strategies. A total of 120 women recently diagnosed with breast cancer, at risk of cardiotoxicity due to anticancer treatment awaiting surgery followed by chemotherapy and/or radiotherapy, will be randomized to either group. In a feasibility study, measurements related to recruitment rate, satisfaction with the program, adherence to them, the retention of participants, safety, and adverse effects will be explored. In the main trial, the efficacy of these interventions will be examined. The major outcome will be cardiotoxicity, assessed echocardiographically via the left ventricular ejection fraction. Other clinical, physical, and anthropometric outcomes and biological and hormonal variables will also be assessed after diagnosis, after treatment, 1 year after treatment ends, and 3 years after treatment ends. CONCLUSION Given its potential effect on patient survival, the mitigation of cardiotoxicity is a priority, and physical therapists have an important role in this mitigation. If the ATOPE intervention performed before treatment returns better cardioprotection results, it may be recommendable that patients recently diagnosed follow this program. IMPACT The ATOPE program will highlight the need for a physical therapist intervention from the moment of diagnosis, in the prevention or mitigation of cardiotoxicity, in women with breast cancer. It could help physical therapists to establish an adequate therapeutic exercise dose adapted to breast cancer patients and to propose correct therapeutic exercise prescription according to the assimilation of the sessions.
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Affiliation(s)
- Paula Postigo-Martin
- Health Sciences Faculty, University of Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain.,Institute for Biomedical Research (ibs.GRANADA), University Hospital Complex of Granada, University of Granada, Granada, Spain
| | | | | | | | - Francisco Artacho-Cordón
- Institute for Biomedical Research (ibs.GRANADA), University Hospital Complex of Granada, University of Granada, Granada, Spain.,Department of Radiology and Physical Medicine, University of Granada, Granada, Spain
| | - Noelia Galiano-Castillo
- Health Sciences Faculty, University of Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain.,Institute for Biomedical Research (ibs.GRANADA), University Hospital Complex of Granada, University of Granada, Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | - Carolina Fernández-Lao
- Health Sciences Faculty, University of Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain.,Institute for Biomedical Research (ibs.GRANADA), University Hospital Complex of Granada, University of Granada, Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | - Lydia Martín-Martín
- Health Sciences Faculty, University of Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain.,Institute for Biomedical Research (ibs.GRANADA), University Hospital Complex of Granada, University of Granada, Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | - Mario Lozano-Lozano
- Health Sciences Faculty, University of Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain.,Institute for Biomedical Research (ibs.GRANADA), University Hospital Complex of Granada, University of Granada, Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | | | - Salvador Moreno-Gutiérrez
- Department of Computer Architecture and Technology, Information and Communication Technologies Research Center (CITIC), University of Granada, Spain
| | | | - Manuel Arroyo-Morales
- Health Sciences Faculty, University of Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain.,Institute for Biomedical Research (ibs.GRANADA), University Hospital Complex of Granada, University of Granada, Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | - Irene Cantarero-Villanueva
- Health Sciences Faculty, University of Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain.,Institute for Biomedical Research (ibs.GRANADA), University Hospital Complex of Granada, University of Granada, Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
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Sayed-Ahmed MM, Alrufaiq BI, Alrikabi A, Abdullah ML, Hafez MM, Al-Shabanah OA. Carnitine Supplementation Attenuates Sunitinib-Induced Inhibition of AMP-Activated Protein Kinase Downstream Signals in Cardiac Tissues. Cardiovasc Toxicol 2020; 19:344-356. [PMID: 30644033 PMCID: PMC6647422 DOI: 10.1007/s12012-018-9500-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This study has been initiated to investigate whether sunitinib (SUN) alters the expression of key genes engaged in mitochondrial transport and oxidation of long chain fatty acids (LCFA), and if so, whether these alterations should be viewed as a mechanism of SUN-induced cardiotoxicity, and to explore the molecular mechanisms whereby carnitine supplementation could attenuate SUN-induced cardiotoxicity. Adult male Wister albino rats were assigned to one of the four treatment groups: Rats in group 1 received no treatment but free access to tap water for 28 days. Rats in group 2 received L-carnitine (200 mg/kg/day) in drinking water for 28 days. Rats in group 3 received SUN (25 mg/kg/day) in drinking water for 28 days. Rats in group 4 received the same doses of L-carnitine and SUN in drinking water for 28 days. Treatment with SUN significantly increased heart weight, cardiac index, and cardiotoxicity enzymatic indices, as well as severe histopathological changes. Moreover, SUN significantly decreased level of adenosine monophosphate-activated protein kinase (AMPKα2), total carnitine, adenosine triphosphate (ATP) and carnitine palmitoyltransferase I (CPT I) expression and significantly increased acetyl-CoA carboxylase-2 (ACC2) expression and malonyl-CoA level in cardiac tissues. Interestingly, carnitine supplementation resulted in a complete reversal of all the biochemical, gene expression and histopathological changes-induced by SUN to the control values. In conclusion, data from this study suggest that SUN inhibits AMPK downstream signaling with the consequent inhibition of mitochondrial transport of LCFA and energy production in cardiac tissues. Carnitine supplementation attenuates SUN-induced cardiotoxicity.
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Affiliation(s)
- Mohamed M Sayed-Ahmed
- Pharmacology, Cancer Biology Department, National Cancer Institute, Cairo University, Cairo, 11796, Egypt
| | - Badr I Alrufaiq
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh, 11451, Kingdom of Saudi Arabia
| | - Ammar Alrikabi
- Pathology Department, College of Medicine, King Saud University, P.O. Box 2457, Riyadh, 11451, Kingdom of Saudi Arabia
| | - Mashan L Abdullah
- King Abdullah International Medical Research Center, P.O. Box 2457, Riyadh, 11451, Kingdom of Saudi Arabia
| | - Mohamed M Hafez
- Virology and Immunology Units, Cancer Biology Department, National Cancer Institute, Cairo University, Cairo, 11796, Egypt
| | - Othman A Al-Shabanah
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh, 11451, Kingdom of Saudi Arabia.
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5
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Clark RA, Marin TS, McCarthy AL, Bradley J, Grover S, Peters R, Karapetis CS, Atherton JJ, Koczwara B. Cardiotoxicity after cancer treatment: a process map of the patient treatment journey. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2019; 5:14. [PMID: 32154020 PMCID: PMC7048085 DOI: 10.1186/s40959-019-0046-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/24/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND/AIM Cardiotoxicity is a potential complication of anticancer therapy. While guidelines have been developed to assist practitioners, an effective, evidence based clinical pathway for the treatment of cardiotoxicity has not yet been developed. The aim of this study was to describe the journey of patients who developed cardiotoxicity through the healthcare system in order to establish baseline data to inform the development and implementation of a patient-centred, evidence-based clinical pathway. METHODS Mixed-methods design with quantitative and qualitative components using process mapping at 3 large medical centres in 2 states between 2010 and 2015. RESULTS Fifty (50) confirmed cases of cardiotoxicity were reviewed (39 medical record reviews, 7 medical record review and interviews and 4 internview only). The mean age at cancer diagnosis of this group was 53.3 years (range 6-89 years); 50% female; 30% breast cancer, 23% non-Hodgkin's lymphoma; mean chemotherapy cycles 5.2 (median 6; range 1-18); 49 (89%) presented to chemotherapy with pre-existing cardiovascular risk factors; 39 (85%) had at least one modifiable risk factor and 11 (24%) had more than 4; 44 (96%) were diagnosed by echocardiogram and 27 (57%) were referred to a cardiologist (only 7 (15%) before chemotherapy). Post chemotherapy, 22 (48%) patients were referred to a multidisciplinary heart failure clinic; 8 (17%) to cardiac rehabilitation; 1 (2%) to cancer survivorship clinic and 10 (22%) to a palliative care service. There were 16 (34%) deaths during the timeframe of the study; 4 (25%) cardiac-related, 6 (38%) cancer-related, 4 (25%) due to sepsis and 2 (12%) other causes not recorded. The main concerns participants raised during the interviews were cancer professionals not discussing the potential for cardiotoxicity with them prior to treatment, nor risk modification strategies; a need for health education, particularly regarding risks for developing heart failure related to cancer treatment; and a lack of collaboration between oncologists and cardiologists. CONCLUSIONS Our results demonstrate that the clinical management of cancer patients with cardiotoxicity was variable and fragmented and not patient centered. This audit establishes practice gaps that can be addressed through the design of an evidence-based clinical pathway for cancer patients with, or at risk, of cardiotoxicity.
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Affiliation(s)
- Robyn A. Clark
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA Australia
| | - Tania S. Marin
- Acute Care & Cardiovascular Research, College of Nursing and Health Sciences, Flinders University, Adelaide, SA Australia
| | - Alexandra L. McCarthy
- Faculty of Health and Medical Sciences, The University of Auckland, Auckland, New Zealand
| | - Julie Bradley
- Royal Adelaide Hospital, North Terrace, Adelaide, SA Australia
| | - Suchi Grover
- Flinders Cardiac Clinic, Flinders Private Hospital, Bedford Park, Adelaide, SA Australia
| | - Robyn Peters
- Heart Recovery Service, Cardiology Department, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Qld Australia
- The University of Queensland, St Lucia Campus, St Lucia, Qld Australia
| | - Christos S. Karapetis
- Department of Medical Oncology and Medical Oncology Clinical Research, Flinders Medical Centre, Flinders Drive, Bedford Park, SA Australia
- Southern Area Local Health Network, SA Health, Adelaide, Australia
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, SA Australia
| | - John J. Atherton
- Royal Brisbane and Women’s Hospital, University of Queensland School of Medicine, Butterfield St & Bowen Bridge Rd, Herston, Qld Australia
| | - Bogda Koczwara
- Flinders Centre for Innovation in Cancer, Flinders Drive, Bedford Park, SA Australia
- Flinders University, Adelaide, SA Australia
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6
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Guha A, Dey AK, Armanious M, Dodd K, Bonsu J, Jneid H, Abraham W, Fradley MG, Addison D. Health care utilization and mortality associated with heart failure-related admissions among cancer patients. ESC Heart Fail 2019; 6:733-746. [PMID: 31264809 PMCID: PMC6676288 DOI: 10.1002/ehf2.12450] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/20/2019] [Accepted: 04/21/2019] [Indexed: 12/13/2022] Open
Abstract
AIMS Heart failure (HF) outcomes continue to improve with widespread use of new therapies. Concurrently, cancer survival has dramatically improved. Yet whether cancer patients share similar strategies and outcomes of inpatient HF treatment to those without HF is unknown. We sought to assess the contemporary impacts of cancer on inpatient HF outcomes over time. METHODS AND RESULTS The retrospective National Inpatient Sample (2003-15) and National Readmissions Database (2013-14) registries were queried for adults admitted for HF and stratified for cancer status, excluding cases of metastatic disease. Temporal trends in HF admissions, hospital charge rates, length of hospitalization, HF-related procedure utilization, in-hospital mortality, and hospital readmissions were analysed. Over 13 years of follow-up, there were 12 769 077 HF admissions (mean age 73 years, 50.8% female, 30.8% non-White), among which 1 413 287 (11%) had a co-morbid cancer diagnosis. Cancer patients were older, were predominantly male, and tended to be smokers. Over time, HF admission rates among cancer patients increased, despite a concurrent decrease among patients without cancer (P < 0.0001). After propensity matching, in-hospital mortality was significantly higher among cancer HF patients (5.1% vs. 2.9%, P < 0.0001). Additionally, HF-related procedure utilization was disproportionately lower among cancer patients (0.30 vs. 0.35 procedures/HF hospitalization, P < 0.001); the presence of cancer was associated with increased costs, length of hospitalizations, and all-cause readmissions, but fewer HF readmissions (P < 0.0001, each). CONCLUSIONS While the incidence of HF hospitalizations has increased among cancer patients, they do not appear to share the same rates of advanced HF care, readmissions trends, or reductions in in-hospital mortality. Future studies targeting modifiable factors related to these differences are needed.
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Affiliation(s)
- Avirup Guha
- Cardio-Oncology Program, Division of Cardiology, Ohio State University, Columbus, OH, USA.,Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, OH, USA
| | - Amit Kumar Dey
- National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Merna Armanious
- Cardio-Oncology Program, Division of Cardiovascular Medicine, University of South Florida Morsani College of Medicine and H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Katherine Dodd
- Cardio-Oncology Program, Division of Cardiology, Ohio State University, Columbus, OH, USA
| | - Janice Bonsu
- Cardio-Oncology Program, Division of Cardiology, Ohio State University, Columbus, OH, USA
| | - Hani Jneid
- Division of Cardiology, Michael E. DeBakey VA Hospital, Baylor College of Medicine, Houston, TX, USA
| | - William Abraham
- Cardio-Oncology Program, Division of Cardiology, Ohio State University, Columbus, OH, USA
| | - Michael G Fradley
- Cardio-Oncology Program, Division of Cardiovascular Medicine, University of South Florida Morsani College of Medicine and H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Daniel Addison
- Cardio-Oncology Program, Division of Cardiology, Ohio State University, Columbus, OH, USA.,Cancer Control Program, Department of Medicine, Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
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7
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SEOM clinical guidelines on cardiovascular toxicity (2018). Clin Transl Oncol 2019; 21:94-105. [PMID: 30627982 PMCID: PMC6339681 DOI: 10.1007/s12094-018-02017-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 12/12/2018] [Indexed: 12/21/2022]
Abstract
One of the most common side effects of cancer treatment is cardiovascular disease, which substantially impacts long-term survivor’s prognosis. Cardiotoxicity can be related with either a direct side effect of antitumor therapies or an accelerated development of cardiovascular diseases in the presence of preexisting risk factors. Even though it is widely recognized as an alarming clinical problem, scientific evidence is scarce in the management of these complications in cancer patients. Consequently, current recommendations are based on expert consensus. This Guideline represents SEOM’s ongoing commitment to progressing and improving supportive care for cancer patients.
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Pituskin E, Paterson I, Cox-Kennett N, Rothe D, Perri M, Becher H. The Role of Cardio-Oncology in the Interprofessional Care of Adult Patients Receiving Cancer Therapy. Semin Oncol Nurs 2017; 33:384-392. [DOI: 10.1016/j.soncn.2017.08.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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9
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Franzon J, Berry NM, Ullah S, Versace VL, McCarthy AL, Atherton J, Roder D, Koczwara B, Coghlan D, Clark RA. Heart failure following blood cancer therapy in pediatric and adult populations. Asia Pac J Clin Oncol 2017; 14:224-230. [PMID: 29024474 DOI: 10.1111/ajco.12782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 08/20/2017] [Indexed: 01/31/2023]
Abstract
AIM The link between chemotherapy treatment and cardiotoxicity is well established, particularly for adults with blood cancers. However, it is less clear for children. This analysis aimed to compare the trajectory and mortality of children and adults who received chemotherapy for blood cancers and were subsequently hospitalized for heart failure. METHODS Linked data from the Queensland Cancer Registry, Death Registry and Hospital Administration records for initial chemotherapy and later heart failure were reviewed (1996-2009). Of all identified blood cancer patients (N = 23 434), 8339 received chemotherapy, including 817 children (aged ≤18 years at time of cancer diagnosis) and 7522 adults. Time-varying Cox proportional hazards regression models were used to compare the characteristics and survival between the two groups. RESULTS Of those who were subsequently hospitalized for heart failure, 70% of children and 46% of adults had the index admission within 12 months of their cancer diagnosis. Of these, 53% of the pediatric heart failure population and 71% of the adult heart failure population died within the study period. Following adjustment for age, sex and chemotherapy admissions, children with heart failure had an increased mortality risk compared to their non-heart failure counterparts, a difference which was much greater than that between the adult groups. CONCLUSION The impact of heart failure on children previously treated for blood cancer is more severe than for adults, with earlier morbidity and greater mortality. Improved strategies are needed for the prevention and management of cardiotoxicity in this population.
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Affiliation(s)
- Julie Franzon
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Narelle M Berry
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.,Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Shahid Ullah
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Vincent L Versace
- Deakin Rural Health, School of Medicine, Deakin University, Warrnambool, Victoria, Australia
| | | | - John Atherton
- Cardiology Department, Royal Brisbane and Women's Hospital and University of Queensland School of Medicine, Brisbane, Queensland, Australia
| | - David Roder
- Cancer Epidemiology and Population Health, Centre for Population Health Research, University of South Australia, Adelaide, Australia
| | - Bogda Koczwara
- Department of Medical Oncology, Flinders Centre for Innovation in Cancer, Flinders University and Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Douglas Coghlan
- Molecular Medicine and Pathology, Haematology, Flinders University, Adelaide, South Australia, Australia
| | - Robyn A Clark
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
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10
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Clark RA, Berry NM, Chowdhury MH, McCarthy AL, Ullah S, Versace VL, Atherton JJ, Koczwara B, Roder D. Heart failure following cancer treatment: characteristics, survival and mortality of a linked health data analysis. Intern Med J 2017; 46:1297-1306. [PMID: 27502031 DOI: 10.1111/imj.13201] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/31/2016] [Accepted: 07/17/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cardiotoxicity resulting in heart failure is a devastating complication of cancer therapy. A patient may survive cancer only to develop heart failure (HF), which has a higher mortality rate than some cancers. AIM This study aimed to describe the characteristics and outcomes of HF in patients with blood or breast cancer after chemotherapy treatment. METHODS Queensland Cancer Registry, Death Registry and Hospital Administration records were linked (1996-2009). Patients were categorised as those with an index HF admission (that occurred after cancer diagnosis) and those without an index HF admission (non-HF). RESULTS A total of 15 987 patients was included, and 1062 (6.6%) had an index HF admission. Median age of HF patients was 67 years (interquartile range 58-75) versus 54 years (interquartile range 44-64) for non-HF patients. More men than women developed HF (48.6% vs 29.5%), and a greater proportion in the HF group had haematological cancer (83.1%) compared with breast cancer (16.9%). After covariate adjustment, HF patients had increased mortality risk compared with non-HF patients (hazard ratios 1.67 (95% confidence interval, 1.54-1.81)), and 47% of the index HF admission occurred within 1 year from cancer diagnosis and 70% within 3 years. CONCLUSION Cancer treatment may place patients at a greater risk of developing HF. The onset of HF occurred soon after chemotherapy, and those who developed HF had a greater mortality risk.
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Affiliation(s)
- R A Clark
- School of Nursing and Midwifery, Flinders University, Adelaide, South Australia, Australia.
| | - N M Berry
- School of Nursing and Midwifery, Flinders University, Adelaide, South Australia, Australia
| | - M H Chowdhury
- School of Nursing and Midwifery, Flinders University, Adelaide, South Australia, Australia
| | - A L McCarthy
- School of Nursing, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - S Ullah
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, South Australia, Australia
| | - V L Versace
- Greater Green Triangle University Department of Rural Health, Flinders University and Deakin University, Warrnambool, Victoria, Australia
| | - J J Atherton
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - B Koczwara
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, South Australia, Australia
| | - D Roder
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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11
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Cascella M. Preoperative cardiac evaluation and anesthetic considerations for cancer patients who underwent chemotherapy. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2017. [DOI: 10.1016/j.tacc.2017.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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12
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Galician consensus on management of cardiotoxicity in breast cancer: risk factors, prevention, and early intervention. Clin Transl Oncol 2017; 19:1067-1078. [PMID: 28342058 PMCID: PMC5547178 DOI: 10.1007/s12094-017-1648-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 03/13/2017] [Indexed: 12/22/2022]
Abstract
This Galician consensus statement is a joint oncologists/cardiologists initiative indented to establish basic recommendations on how to prevent and to manage the cardiotoxicity in breast cancer with the aim of ensuring an optimal cardiovascular care of these patients. A clinical screening of the patients before treatment is recommended to stratify them into a determined risk group based on their intrinsic cardiovascular risk factors and those extrinsic arose from breast cancer therapy, thereby providing individualized preventive and monitoring measures. Suitable initial and ongoing assessments for patients with low and moderate/high risk and planned treatment with anthracyclines and trastuzumab are given; also, measures aimed at preventing and correcting any modifiable risk factor are pointed out .
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Abstract
Cancer and cardiovascular disease account for nearly half of all deaths in the US. The majority of cancer therapies are known to cause potential cardiac toxicity in some form. Patients with underlying cardiac disease are at a particularly increased risk for worse outcomes following cancer therapy. Most alarming is the potential for heart failure as a result of cancer treatment, which may lead to early disruption or withdrawal of life-saving cancer therapies and can potentially increase cardiovascular mortality. A multi-disciplinary cardio-oncology approach can improve outcomes through early surveillance, prevention and treatment strategies.
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Affiliation(s)
- Carine E Hamo
- Department of Medicine, Stony Brook University Hospital, Stony Brook, New York, US
| | - Michelle W Bloom
- Department of Medicine, Stony Brook University Hospital, Stony Brook, New York, US
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14
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Rationale and design of the multidisciplinary team IntervenTion in cArdio-oNcology study (TITAN). BMC Cancer 2016; 16:733. [PMID: 27629548 PMCID: PMC5024526 DOI: 10.1186/s12885-016-2761-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 09/06/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Cancer is the leading cause of premature death in Canada. In the last decade, important gains in cancer survival have been achieved by advances in adjuvant treatment. However, many oncologic treatments also result in cardiovascular "toxicity". Furthermore, cardiac risk factors such as hypertension, dyslipidemia, and diabetes mellitus are known to contribute to the progression of cardiac damage and clinical cardiotoxicity. As such, for many survivors, the risk of death from cardiac disease exceeds that of recurrent cancer. While provision of care by multidisciplinary teams has been shown to reduce mortality and hospitalizations among heart failure patients, the effect of assessments and interventions by multidisciplinary specialists in cancer patients receiving cardiotoxic chemotherapy regimens is currently unknown. Accordingly, we will examine the effect of a multi-disciplinary team interventions in the early assessment, identification and treatment of cardiovascular risk factors in cancer patients receiving adjuvant systemic therapy. Our main hypothesis is to determine if the incidence of LV dysfunction in cancer patients undergoing adjuvant therapy can be reduced through a multidisciplinary team approach. METHODS/DESIGN This is a randomized study comparing intensive multidisciplinary team intervention to usual care in the prevention of LV remodeling in patients receiving anthracycline or trastuzumab-based chemotherapy. Main objectives include early detection strategies for cardiotoxicity using novel biomarkers that reflect myocardial injury, remodeling and/or dysfunction; early identification and intensive treatment of cardiovascular risk factors; and early intervention with supportive care strategies including nutritional and pharmacist counselling, exercise training and cardiology team support. Secondary objectives include correlation of novel biomarkers to clinical outcomes; correlation of multidisciplinary interventions to adverse clinical outcomes; relationship of multidisciplinary interventions and chemotherapy dose density; preservation of lean muscle mass; and patient reported outcomes (symptom intensity and quality of life). DISCUSSION Cardiac toxicity as a result of cancer therapies is now recognized as a significant health problem of increasing prevalence. To our knowledge, TITAN will be the first randomized trial examining the utility of multidisciplinary team care in the prevention of cardiotoxicity. We expect our results to inform comprehensive and holistic care for patients at risk for negative cancer therapy mediated sequelae. TRIAL REGISTRATION ClinicalTrials.gov, NCT01621659 Registration Date 4 June 2012.
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Yang Y, Bu P. Progress on the cardiotoxicity of sunitinib: Prognostic significance, mechanism and protective therapies. Chem Biol Interact 2016; 257:125-31. [PMID: 27531228 DOI: 10.1016/j.cbi.2016.08.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 07/23/2016] [Accepted: 08/05/2016] [Indexed: 12/15/2022]
Abstract
Tyrosine kinase inhibitors (TKIs) are multi-targeted anti-cancer agents effective in the treatment of renal cell carcinoma (RCC), imatinib-resistant gastrointestinal stromal tumor (GIST) and pancreatic cancer (PC). Targeting and inhibiting a wide range of oncogenically relevant receptor tyrosine kinases (RTKs), TKIs have been the golden standard treatment of several types of cancer. The cardiotoxicity of TKIs, however, has also emerged alongside their anti-cancer potencies and has attracted research attention. Over the past few years significant progress has been made in developing a deeper understanding of aspects such as extent of cardiotoxicity, prognostic implications and survival predictions, toxicological mechanisms, and potential cardioprotective therapies. In this review we focus on a typical TKI sunitinib and summarize the up-to-date knowledge of sunitinib-induced cardiac abnormalities reported in clinical studies, weighing their implications of prognostic values. We also examine recent findings in underlying mechanisms, and development of potential cardioprotective agents.
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Affiliation(s)
- Yi Yang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health; The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Peili Bu
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health; The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, Shandong, China.
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16
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Riccio G, Coppola C, Piscopo G, Capasso I, Maurea C, Esposito E, De Lorenzo C, Maurea N. Trastuzumab and target-therapy side effects: Is still valid to differentiate anthracycline Type I from Type II cardiomyopathies? Hum Vaccin Immunother 2016; 12:1124-31. [PMID: 26836985 PMCID: PMC4963071 DOI: 10.1080/21645515.2015.1125056] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The improvement in cancer therapy and the increasing number of long term survivors unearth the issue of cardiovascular side effects of anticancer treatments. As a paradox in cancer survivors, delayed cardiotoxicity has emerged as a significant problem. Two categories of cardiotoxic side effects of antineoplastic drugs have been previously proposed: Type I cardiotoxicity, defined as permanent cardiotoxicity, is usually caused by anthracyclines; Type II cardiotoxicity, considered as reversible cardiotoxicity, has been mainly related to monoclonal antibodies. The cardiotoxicity of antibodies has been associated to trastuzumab, a humanized anti-ErbB2 monoclonal antibody currently in clinical use for the therapy of breast carcinomas, which induces cardiac dysfunction when used in monotherapy, or in combination with anthracyclines. Furthermore, recent retrospective studies have shown an increased incidence of heart failure and/or cardiomyopathy in patients treated with trastuzumab, that can persist many years after the conclusion of the therapy, thus suggesting that the side toxic effects are not always reversible as it was initially proposed. On the other hand, early detection and prompt therapy of anthracycline associated cardiotoxicity can lead to substantial recovery of cardiac function. On the basis of these observations, we propose to find a new different classification for cardiotoxic side effects of drugs used in cancer therapy.
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Affiliation(s)
- Gennaro Riccio
- a Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" -IRCCS - Naples , Italy
| | - Carmela Coppola
- a Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" -IRCCS - Naples , Italy
| | - Giovanna Piscopo
- a Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" -IRCCS - Naples , Italy
| | - Immacolata Capasso
- a Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" -IRCCS - Naples , Italy
| | - Carlo Maurea
- a Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" -IRCCS - Naples , Italy
| | - Emanuela Esposito
- a Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" -IRCCS - Naples , Italy
| | - Claudia De Lorenzo
- b CEINGE Biotecnologie Avanzate , Naples , Italy.,c Dipartimento di Medicina Molecolare e Biotecnologie Mediche , Università Federico II , Naples , Italy
| | - Nicola Maurea
- a Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" -IRCCS - Naples , Italy
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Hamo CE, Bloom MW. Getting to the Heart of the Matter: An Overview of Cardiac Toxicity Related to Cancer Therapy. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2015; 9:47-51. [PMID: 26309419 PMCID: PMC4525792 DOI: 10.4137/cmc.s19704] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 07/01/2015] [Accepted: 07/08/2015] [Indexed: 02/06/2023]
Abstract
With the improvement in cancer survival, long-term cardiotoxicity has become an area of increased interest. Various cancer therapies, including chemotherapy and radiation therapy can lead to cardiac toxicities with both acute and chronic manifestations. Awareness and early recognition can lead to improvement in cardiac survival and patient outcomes. The focus of this review is to summarize the cancer therapy agents most often associated with cardiovascular side effects, highlighting their mechanism of action and strategies for surveillance and prevention.
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Affiliation(s)
- Carine E Hamo
- Department of Medicine, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Michelle Weisfelner Bloom
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY, USA
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18
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Said R, Tsimberidou AM. Left ventricular ejection fraction in advanced cancer patients: a valuable prognostic tool? Future Oncol 2015. [DOI: 10.2217/fon.15.82] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Rabih Said
- Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Unit 455, 1515 Holcombe Boulevard, Houston, TX 77030, USA
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Apostolia M Tsimberidou
- Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Unit 455, 1515 Holcombe Boulevard, Houston, TX 77030, USA
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Conway A, McCarthy AL, Lawrence P, Clark RA. The prevention, detection and management of cancer treatment-induced cardiotoxicity: a meta-review. BMC Cancer 2015; 15:366. [PMID: 25948399 PMCID: PMC4427936 DOI: 10.1186/s12885-015-1407-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 04/29/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The benefits associated with some cancer treatments do not come without risk. A serious side effect of some common cancer treatments is cardiotoxicity. Increased recognition of the public health implications of cancer treatment-induced cardiotoxicity has resulted in a proliferation of systematic reviews in this field to guide practice. Quality appraisal of these reviews is likely to limit the influence of biased conclusions from systematic reviews that have used poor methodology related to clinical decision-making. The aim of this meta-review is to appraise and synthesise evidence from only high quality systematic reviews focused on the prevention, detection or management of cancer treatment-induced cardiotoxicity. METHODS Using Cochrane methodology, we searched databases, citations and hand-searched bibliographies. Two reviewers independently appraised reviews and extracted findings. A total of 18 high quality systematic reviews were subsequently analysed, 67 % (n = 12) of these comprised meta-analyses. RESULTS One systematic review concluded that there is insufficient evidence regarding the utility of cardiac biomarkers for the detection of cardiotoxicity. The following strategies might reduce the risk of cardiotoxicity: 1) The concomitant administration of dexrazoxane with anthracylines; 2) The avoidance of anthracyclines where possible; 3) The continuous administration of anthracyclines (>6 h) rather than bolus dosing; and 4) The administration of anthracycline derivatives such as epirubicin or liposomal-encapsulated doxorubicin instead of doxorubicin. In terms of management, one review focused on medical interventions for treating anthracycline-induced cardiotoxicity during or after treatment of childhood cancer. Neither intervention (enalapril and phosphocreatine) was associated with statistically significant improvement in ejection fraction or mortality. CONCLUSION This review highlights the lack of high level evidence to guide clinical decision-making with respect to the detection and management of cancer treatment-associated cardiotoxicity. There is more evidence with respect to the prevention of this adverse effect of cancer treatment. This evidence, however, only applies to anthracycline-based chemotherapy in a predominantly adult population. There is no high-level evidence to guide clinical decision-making regarding the prevention, detection or management of radiation-induced cardiotoxicity.
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Affiliation(s)
- Aaron Conway
- School of Nursing, Institute of Health and Biomedical Innovation, Queensland University Technology, Kelvin Grove Campus, Kelvin Grove, QLD, 4059, Australia.
| | - Alexandra L McCarthy
- Division of Cancer Services, Princess Alexandra Hospital and School of Nursing, Institute of Health and Biomedical Innovation, Queensland University Technology, Kelvin Grove Campus, Kelvin Grove, QLD, 4059, Australia.
| | - Petra Lawrence
- Nursing Research & Practice Development Unit The Prince Charles Hospital and School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Brisbane, QLD, Australia.
| | - Robyn A Clark
- School of Nursing and Midwifery, Flinders University, 5042 GPO Box 2100, , Sturt Road, Bedford Park, Adelaide, 5001, South Australia.
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Fabian C. Prevention and Treatment of Cardiac Dysfunction in Breast Cancer Survivors. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 862:213-30. [PMID: 26059938 DOI: 10.1007/978-3-319-16366-6_14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
As recurrence free survival following a breast cancer diagnosis continues to improve, cardiovascular morbidity and mortality will assume greater importance in the breast cancer survivorship research agenda particularly for women receiving potentially cardiotoxic therapy. Development of (1) tools to readily identify pre-diagnostic risk factors for cardiac dysfunction, (2) well-tolerated prophylactic treatments to reduce the risk of cardiac injury, and (3) sensitive and affordable monitoring techniques which can identify subclinical toxicity prior to a drop in left ventricular ejection fraction are or should be focus areas of cardio-oncology research. Since weight as well as cardiorespiratory fitness generally decline after a breast cancer diagnosis, behavioral approaches which can improve energy balance and fitness are important to optimize cardiovascular health in all breast cancer survivors not just those undergoing cardiotoxic therapy. These goals are likely best achieved by partnerships between cardiologists, oncologists and internists such as those initiated with the formation of the International CardiOncology Society (ICOS) and the NCI Community Cardiotoxicity Task Force.
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Affiliation(s)
- Carol Fabian
- Breast Cancer Prevention and Survivorship Center, University of Kansas Cancer Center, 2330 Shawnee Mission Parkway Suite 1102, Westwood, KS, 66205, USA,
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Blechman I, Arad M, Nussbaum T, Goldenberg I, Freimark D. Predictors and outcome of sustained improvement in left ventricular function in dilated cardiomyopathy. Clin Cardiol 2014; 37:687-92. [PMID: 25236761 DOI: 10.1002/clc.22331] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 05/28/2014] [Accepted: 08/04/2014] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Improvement in the left ventricular ejection fraction (LVEF) may occur in patients with dilated cardiomyopathy (DCM). HYPOTHESIS There are different implications of persistent versus transient improvement in LVEF among DCM patients receiving contemporary therapy. METHODS We studied 188 patients with nonischemic DCM. Persistent improvement in LVEF (PIEF) was defined as LVEF increase by at least 10% compared to baseline, and found in 2 separate echo-Doppler exams performed at least 12 months apart. Increased LVEF in echo 2, which was not sustained in echo 3, was defined as transient improvement in LVEF (TIEF). RESULTS Over an average follow-up of 6.8 years, PIEF occurred in 61 (33%) patients, predicting a better long-term outcome (P < 0.001) in a combined end-point comprising death, heart transplantation, or the need for a ventricular assist device. The TIEF group had an intermediate course and were closer to nonimprovers (P = 0.003 vs PIEF). Multivariate logistic regression identified the following independent predictors of PIEF: shorter disease duration, pregnancy-associated disease, left ventricular hypertrophy, and baseline LVEF ≤ 25%. A score to predict PIEF assigned 1 point to each of the following: disease duration < 3 years and no familial cardiomyopathy; pregnancy-associated presentation; basal LVEF ≤ 25%; and left ventricular wall thickness ≥ 12. A score of ≥ 3 was present in 44% of the patients, reliably predicting PIEF in 91% (P = 0.01). CONCLUSIONS Persistent improvement in LVEF is associated with improved long-term prognosis. Baseline clinical parameters can be used to identify patients likely to demonstrate PIEF, thereby allowing tailored management in this population.
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Affiliation(s)
- Ido Blechman
- Heart Failure Institute and Leviev Heart Center, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Cancer Therapy-Induced Left Ventricular Dysfunction: Interventions and Prognosis. J Card Fail 2014; 20:155-8. [DOI: 10.1016/j.cardfail.2013.12.018] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 12/19/2013] [Accepted: 12/20/2013] [Indexed: 11/20/2022]
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McCarthy A, Yates P, Shaban R. Cross-sectional survey of the health behaviour of southeast Queensland women with cancer-treatment induced menopause: Implications for cancer and primary care nurses. Collegian 2013; 20:223-31. [DOI: 10.1016/j.colegn.2012.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Stoodley PW, Richards DA, Boyd A, Hui R, Harnett PR, Meikle SR, Byth K, Stuart K, Clarke JL, Thomas L. Left ventricular systolic function in HER2/neu negative breast cancer patients treated with anthracycline chemotherapy: A comparative analysis of left ventricular ejection fraction and myocardial strain imaging over 12 months. Eur J Cancer 2013; 49:3396-403. [DOI: 10.1016/j.ejca.2013.06.046] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 06/14/2013] [Accepted: 06/28/2013] [Indexed: 11/17/2022]
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Orsucci D, Pizzanelli C, Moretti P, Siciliano G. Reply to the letter. Neuromuscul Disord 2013; 23:525. [DOI: 10.1016/j.nmd.2013.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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26
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Cardinale D. Treatment and prevention of cardiotoxicity due to anticancer therapy. J Cardiovasc Echogr 2011. [DOI: 10.1016/j.jcecho.2011.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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