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Titus A, Cheema HA, Shafiee A, Seighali N, Shahid A, Bhanushali KB, Kumar A, Khan SU, Khadke S, Thavendiranathan P, Hundley WG, Scherrer-Crosbie M, Nohria A, Neilan TG, Dani SS, Nasir K, Ganatra S. Statins for Attenuating Cardiotoxicity in Patients Receiving Anthracyclines: A Systematic Review and Meta-Analysis. Curr Probl Cardiol 2023; 48:101885. [PMID: 37336312 DOI: 10.1016/j.cpcardiol.2023.101885] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 06/13/2023] [Indexed: 06/21/2023]
Abstract
Anthracycline chemotherapy causes cardiotoxicity, and the evidence regarding the benefit of concomitant statin use in reducing it remains uncertain. We conducted a meta-analysis of studies using statins and anthracyclines by searching PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov from inception until April 10, 2023. Our analysis included 3 observational studies and 4 RCTs, including the STOP-CA trial released in ACC23. Statin prescription significantly reduced cardiotoxicity in cancer patients receiving anthracycline chemotherapy (OR 0.46, 95% CI: 0.33-0.63; I2: 0%). However, no significant difference was observed in the decline of left ventricular ejection fraction (LVEF) from baseline (MD 4.15, 95% CI: -0.69 to 8.99, I2: 97%). These findings demonstrate the protective effect of concomitant statin prescription.
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Affiliation(s)
- Anoop Titus
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA
| | | | - Arman Shafiee
- Clinical Research Development Unit, Alborz University of Medical Sciences, Karaj, Iran; Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Niloofar Seighali
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Abia Shahid
- Department of Cardiology, King Edward Medical University, Lahore, Pakistan
| | - Karan B Bhanushali
- Department of Internal Medicine, Roger Williams Medical Center, Providence, RI
| | - Ashish Kumar
- Department of Internal Medicine, Cleveland Clinic, Akron General, OH
| | - Safi U Khan
- Division of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX
| | - Sumanth Khadke
- Department of Cardiovascular Medicine, Cardio-Oncology Program, Landsman Heart and Vasculature Center, Lahey Hospital & Medical Center, Burlington, MA
| | - Paaladinesh Thavendiranathan
- Department of Medicine, Division of Cardiology, Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - W Gregory Hundley
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA
| | | | - Anju Nohria
- Cardiovascular Division, Department of Internal Medicine, Cardio-Oncology Program, Brigham and Women's Hospital, Boston, MA
| | - Tomas G Neilan
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Cardio-oncology Program, Harvard Medical School, Boston, MA
| | - Sourbha S Dani
- Department of Cardiovascular Medicine, Cardio-Oncology Program, Landsman Heart and Vasculature Center, Lahey Hospital & Medical Center, Burlington, MA
| | - Khurram Nasir
- Division of Cardiovascular Prevention & Wellness, Houston Methodist Hospital, Houston, TX
| | - Sarju Ganatra
- Department of Cardiovascular Medicine, Cardio-Oncology Program, Landsman Heart and Vasculature Center, Lahey Hospital & Medical Center, Burlington, MA.
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Almuwaqqat Z, Hung O, Parashar S. Statins and cancer survivors: the need for structured guidelines. Future Cardiol 2018; 14:5-8. [DOI: 10.2217/fca-2017-0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Zakaria Almuwaqqat
- Department of Medicine, Emory School of Medicine, Atlanta, GA 30322, USA
- Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Olivia Hung
- Division of Cardiology, Department of Medicine, Emory School of Medicine, Atlanta, GA 30322, USA
| | - Susmita Parashar
- Division of Cardiology, Department of Medicine, Emory School of Medicine, Atlanta, GA 30322, USA
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Ewer MS, Patel K, O'Brien D, Lorence RM. Cardiac safety of afatinib: a review of data from clinical trials. CARDIO-ONCOLOGY 2015; 1:3. [PMID: 33530147 PMCID: PMC7837143 DOI: 10.1186/s40959-015-0006-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 10/29/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND Afatinib is an oral irreversible ErbB family blocker that targets epidermal growth factor receptor (EGFR/ErbB1), human epidermal growth factor receptor 2 (HER2/ErbB2), and HER4 (ErbB4) and is approved for the first-line treatment of advanced non-small cell lung cancer (NSCLC) with certain sensitizing EGFR mutations. As anti-HER2 therapies have been associated with cardiac dysfunction, we report cardiac safety data for afatinib. METHODS Cardiac data were analyzed from phase III trials of afatinib 40 mg in treatment-naive patients with EGFR mutation-positive NSCLC (LUX-Lung 3 [LL3]; n = 229 afatinib, n = 111 chemotherapy) and afatinib 50 mg in EGFR tyrosine kinase inhibitor-pretreated NSCLC patients (LUX-Lung 1 [LL1]; n = 390 afatinib, n = 195 placebo). Additional pooled data from 49 trials (n = 3865 afatinib-treated patients) is reported. Cardiac failure adverse events (CF-AEs), including symptomatic cardiac failure and depressed left ventricular ejection fraction (LVEF), were analyzed. RESULTS Time at risk-adjusted CF-AE rates (events/100 patient-years) were similar for afatinib versus placebo in LL1 (2.40 vs 2.23) and versus chemotherapy in LL3 (2.28 vs 2.92); the pooled afatinib CF-AE rate (2.88) was consistent with that for both trials. The frequency of clinically significant LVEF reductions was higher for chemotherapy in LL3 (2/15 [13.3 %], afatinib 13/208 [6.3 %]; p = 0.267) and similar to placebo in LL1 (5/122 [4.1 %], afatinib 14/304 [4.6 %]; p = 1.000). CONCLUSION Afatinib was not associated with cardiac failure or LVEF reductions in the afatinib clinical trial program.
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Affiliation(s)
- Michael S Ewer
- Department of Cardiology, Division of Medical Specialties, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA.
| | - Kalpesh Patel
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
| | - Dennis O'Brien
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
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Théon AP, Pusterla N, Magdesian KG, Wilson WD. Phase I dose escalation of doxorubicin chemotherapy in tumor-bearing equidae. J Vet Intern Med 2013; 27:1209-17. [PMID: 23889748 DOI: 10.1111/jvim.12145] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 04/15/2013] [Accepted: 06/04/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There is no information on the use of doxorubicin in horses with tumors. OBJECTIVE To determine dose-limiting toxicosis (DLT) and maximum tolerated dose (MTD) of doxorubicin in tumor-bearing horses. ANIMALS Seventeen horses with 34 localized or multicentric advanced tumors. METHODS Two-stage dose-ranging design involving intrapatient and interpatient dose escalation. Treatment protocol included 6 treatment cycles given at 3-week intervals with dosages ranging from 40 to 85 mg/m(2). Clinical signs, hematologic, and nonhematologic changes were evaluated. RESULTS Total doses ranged from 1,127 to 2,900 mg in 12 horses that completed the assigned treatment protocols. The MTD was 75 mg/m(2). Hypersensitivity reactions and neutropenia were dose limiting. Hypersensitivity was dose-dependent but schedule invariant. Neutropenia was dose- and cycle-dependent but dose-escalation schedule invariant. Cardiotoxicity was not observed. CONCLUSION AND CLINICAL RELEVANCE The recommended dosage of doxorubicin to treat horses is 70 mg/m(2) given at 3-week intervals as single agent. Adjunctive treatment with antihistamines and nonsteroidal anti-inflammatory drugs is recommended to control hypersensitivity.
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Affiliation(s)
- A P Théon
- Departments of Surgery and Radiology, University of California, Davis, CA
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Acar Z, Kale A, Turgut M, Demircan S, Durna K, Demir S, Meriç M, Ağaç MT. Efficiency of atorvastatin in the protection of anthracycline-induced cardiomyopathy. J Am Coll Cardiol 2011; 58:988-9. [PMID: 21851890 DOI: 10.1016/j.jacc.2011.05.025] [Citation(s) in RCA: 166] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 05/11/2011] [Accepted: 05/17/2011] [Indexed: 10/17/2022]
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Saini L, Alibhai SMH, Brandwein JM. Quality of life issues in elderly acute myeloid leukemia patients. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/ahe.11.32] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The median age of acute myeloid leukemia (AML) is 70 years. Treatment approaches include standard chemotherapy, palliative chemotherapy and investigational agents, depending upon disease biology and patient factors. In this article, we highlight the issues involved in the treatment of AML in older patients, focusing on the quality of life changes associated with each treatment modality at different stages of their disease course. We further discuss recent insights into the biological basis of quality of life changes, and examine potential ways to improve these through pharmacological and nonpharmacological means. Finally, we explore avenues for future research into the quality of life of the older AML patient.
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Affiliation(s)
- Lalit Saini
- Department of Medical Oncology & Hematology, Princess Margaret Hospital, 610 University Avenue, Rm. 5–109, Toronto, ON M5G 2M9, Canada
| | - Shabbir MH Alibhai
- Department of Medicine, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada
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Li YF, Wang X. The role of the proteasome in heart disease. BIOCHIMICA ET BIOPHYSICA ACTA 2011; 1809:141-9. [PMID: 20840877 PMCID: PMC3021001 DOI: 10.1016/j.bbagrm.2010.09.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2010] [Revised: 09/01/2010] [Accepted: 09/02/2010] [Indexed: 01/23/2023]
Abstract
Intensive investigations into the pathophysiological significance of the proteasome in the heart did not start until the beginning of the past decade but exciting progress has been made and summarized here as two fronts. First, strong evidence continues to emerge to support a novel hypothesis that proteasome functional insufficiency represents a common pathological phenomenon in a large subset of heart disease, compromises protein quality control in heart muscle cells, and thereby acts as a major pathogenic factor promoting the progression of the subset of heart disease to congestive heart failure. This front is represented by the studies on the ubiquitin-proteasome system (UPS) in cardiac proteinopathy, which have taken advantage of a transgenic mouse model expressing a fluorescence reporter for UPS proteolytic function. Second, pharmacological inhibition of the proteasome has been explored experimentally as a potential therapeutic strategy to intervene on some forms of heart disease, such as pressure-overload cardiac hypertrophy, viral myocarditis, and myocardial ischemic injury. Not only between the two fronts but also within each one, a multitude of inconsistencies and controversies remain to be explained and clarified. At present, the controversy perhaps reflects the sophistication of cardiac proteasomes in terms of the composition, assembly, and regulation, as well as the intricacy and diversity of heart disease in terms of its etiology and pathogenesis. A definitive role of altered proteasome function in the development of various forms of heart disease remains to be established. This article is part of a Special Issue entitled The 26S Proteasome: When degradation is just not enough!
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Affiliation(s)
- Yi-Fan Li
- Division of Basic, Biomedical Sciences, Sanford School of Medicine of the University of South Dakota, Vermillion, SD 57069, USA
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Creutzig U, Zimmermann M, Dworzak M, Urban C, Henze G, Kremens B, Lakomek M, Bourquin JP, Stary J, Reinhardt D. Favourable outcome of patients with childhood acute promyelocytic leukaemia after treatment with reduced cumulative anthracycline doses. Br J Haematol 2010; 149:399-409. [DOI: 10.1111/j.1365-2141.2010.08107.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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