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Kamphuis JAM, Linschoten M, Cramer MJ, Gort EH, van Rhenen A, Asselbergs FW, Doevendans PA, Teske AJ. Cancer Therapy-Related Cardiac Dysfunction of Nonanthracycline Chemotherapeutics: What Is the Evidence? JACC: CARDIOONCOLOGY 2019; 1:280-290. [PMID: 34396190 PMCID: PMC8352330 DOI: 10.1016/j.jaccao.2019.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/26/2019] [Accepted: 09/04/2019] [Indexed: 11/07/2022]
Abstract
Cancer therapy–related cardiac dysfunction (CTRCD) is one of the most concerning cardiovascular side effects of cancer treatment. Important reviews within the field of cardio-oncology have described various agents to be associated with a high risk of CTRCD, including mitomycin C, ifosfamide, vincristine, cyclophosphamide, and clofarabine. The aim of this study was to provide insight into the data on which these incidence rates are based. We observed that the reported cardiotoxicity of mitomycin C and ifosfamide is based on studies in which most patients received anthracyclines, complicating the interpretation of their association with CTRCD. The high incidence of vincristine-induced cardiotoxicity is based on an incorrect interpretation of a single study. Incidence rates of clofarabine remain uncertain due to a lack of cardiac screening in clinical trials. The administration of high-dose cyclophosphamide (>1.5 g/m2/day) is associated with a high incidence of CTRCD. Based on our findings, a critical re-evaluation of the cardiotoxicity of these agents is warranted. CTRCD is one of the most concerning cardiovascular side effects of anticancer treatment. Mitomycin C, ifosfamide, cyclophosphamide, clofarabine, and vincristine are frequently recognized as being highly cardiotoxic, causing CTRCD in ≥10% of patients. This primer provides insight into the data upon which the CTRCD incidence rates of these agents have been based. A critical re-evaluation of CTRCD rates is necessary because these numbers have been based on data in which most patients received prior or concurrent treatment with other cardiotoxic drugs, including anthracyclines. Systematic reviews, meta-analyses, consistent and detailed reporting of cardiovascular toxicity, and international registries are of pivotal importance to establish the cardiotoxicity profile of these chemotherapeutics.
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Affiliation(s)
- Janine A M Kamphuis
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Marijke Linschoten
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Maarten J Cramer
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Eelke H Gort
- Department of Medical Oncology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Anna van Rhenen
- Department of Haematology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands.,Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, United Kingdom.,Health Data Research UK and Institute of Health Informatics, University College London, London, United Kingdom
| | - Pieter A Doevendans
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands.,Netherlands Heart Institute, Utrecht, the Netherlands
| | - Arco J Teske
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
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Mondesir J, Alary AS, Sibon D, Willems L, Deau B, Suarez F, Hermine O, Fontenay M, Bouscary D, Kosmider O, Tamburini J. Impact of genotype in relapsed and refractory acute myeloid leukaemia patients treated with clofarabine and cytarabine: a retrospective study. Br J Haematol 2019; 187:65-72. [PMID: 31215036 DOI: 10.1111/bjh.16045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 04/16/2019] [Indexed: 12/01/2022]
Abstract
The treatment of relapsed/refractory (R/R) acute myeloid leukaemia (AML) remains a challenge. Among salvage chemotherapy regimens, the clofarabine and cytarabine (CLARA) combination has been widely evaluated and has a favourable safety/efficacy balance. Predictive factors of efficacy in patients with R/R AML are unclear, particularly the impact of AML-related gene mutations. We report our single-centre experience on 34 R/R AML patients treated with CLARA, with a focus on the genetic characterization of our cohort. CLARA yielded a 47% response rate among this poor-prognosis AML population, while two patients (5·8%) died due to treatment-related toxicity. The two-year progression-free survival and overall survival rates were 29·4% and 35·3%, respectively. Nine patients (26%) had long-term response with a median follow-up of 39·5 months among the responders, of whom six underwent haematopoietic stem cell transplantation. Adverse karyotype did not correlate with response or survival, and secondary AML were more frequent among responders to CLARA, suggesting that this combination may successfully salvage R/R AML patients regardless of adverse prognostic markers. We also observed that a low mutational burden and absence of splice mutations correlated with prolonged survival after CLARA, suggesting that extensive genotyping may have prognostic implications in R/R AML.
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Affiliation(s)
- Johanna Mondesir
- Faculté de Médecine Sorbonne Paris Cité, Université Paris Descartes, Paris, France.,Haematology Department, Cochin Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Anne-Sophie Alary
- Faculté de Médecine Sorbonne Paris Cité, Université Paris Descartes, Paris, France.,Haematology Laboratory, Cochin Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - David Sibon
- Faculté de Médecine Sorbonne Paris Cité, Université Paris Descartes, Paris, France.,Haematology Department, Necker Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Lise Willems
- Faculté de Médecine Sorbonne Paris Cité, Université Paris Descartes, Paris, France.,Haematology Department, Cochin Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Benedicte Deau
- Faculté de Médecine Sorbonne Paris Cité, Université Paris Descartes, Paris, France.,Haematology Department, Cochin Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Felipe Suarez
- Faculté de Médecine Sorbonne Paris Cité, Université Paris Descartes, Paris, France.,Haematology Department, Necker Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Olivier Hermine
- Faculté de Médecine Sorbonne Paris Cité, Université Paris Descartes, Paris, France.,Haematology Department, Necker Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Michaela Fontenay
- Faculté de Médecine Sorbonne Paris Cité, Université Paris Descartes, Paris, France.,Haematology Laboratory, Cochin Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Didier Bouscary
- Faculté de Médecine Sorbonne Paris Cité, Université Paris Descartes, Paris, France.,Haematology Department, Cochin Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Olivier Kosmider
- Faculté de Médecine Sorbonne Paris Cité, Université Paris Descartes, Paris, France.,Haematology Laboratory, Cochin Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Jerome Tamburini
- Faculté de Médecine Sorbonne Paris Cité, Université Paris Descartes, Paris, France.,Haematology Laboratory, Cochin Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
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