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Orlando L, Maiello E, Orditura M, Diana A, Antoniol G, Morritti MG, Aieta M, Ciccarese M, Pisconti S, Bordonaro R, Russo A, Febbraro A, Schiavone P, Quaranta A, Caliolo C, Loparco D, Cinefra M, Colucci G, Cinieri S. Phase II randomized trial comparing metronomic anthracycline-containing chemotherapy versus standard schedule in untreated HER2 negative advanced breast cancer: activity and quality of life results of the GOIM 21003 trial. Breast 2024; 75:103725. [PMID: 38615483 PMCID: PMC11021991 DOI: 10.1016/j.breast.2024.103725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 03/03/2024] [Accepted: 04/01/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Optimizing chemotherapy to achieve disease and symptoms control is a noteworthy purpose in advanced breast cancer (ABC). We reported the activity and quality of life of a phase II study, comparing metronomic regimen with standard schedule as first line chemotherapy for ABC. METHODS Patients with HER2 negative ABC were randomized to non-pegylated liposomal doxorubicin (NPLD, 60 mg/m2 every 3 weeks) and cyclophosphamide (CTX, 600 mg/m2 every 3 weeks) (Arm A) or NPLD (20 mg/m2 day, on day 1, 8 and 15 every 4 weeks) and metronomic daily oral CTX 50 mg (ARM B). Primary end-points were overall response rate (ORR) and quality of life, secondary progression-free survival (PFS), overall survival (OS) and toxicity. RESULTS From August 2012 to December 2017, 121 patients were enrolled, 105 evaluable. Median follow-up was 21.3 months. Most patients had hormone receptor positive. ORR was 43 % in arm A and 50 % in arm B. Median PFS was 8.9 months in arm A and 6,4 months in arm B. There was no difference in OS. Total score was not clinically different between the two arms. Grade 4 neutropenia was observed in 12 patients and 16 patients respectively; alopecia G2 in 41 % (77 %) vs 14 (27 %) in arm A and in arm B respectively. One cardiac toxicity was observed (arm A). CONCLUSIONS First line metronomic chemotherapy for HER2 negative ABC had similar clinical activity and quite better tolerability than standard schedule and could be considered a further treatment option when chemotherapy is indicated.
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Affiliation(s)
- Laura Orlando
- Medical Oncology Division, "Antonio Perrino" Hospital, Brindisi, Italy.
| | - Evaristo Maiello
- Medical Oncology Division, "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | | | - Anna Diana
- Medical Oncology Division, Ospedale del Mare, Napoli, Italy
| | | | - Maria Grazia Morritti
- Medical Oncology Division, "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Michele Aieta
- Hemato-Oncology Department, CROB-IRCCS, Rionero in Vulture, Potenza, Italy
| | | | - Salvatore Pisconti
- Medical Oncology Division, "San Giuseppe Moscati" Hospital, Taranto, Italy
| | | | - Antonio Russo
- Medical Oncology Division, "Paolo Giaccone" Hospital, Palermo, Italy
| | - Antonio Febbraro
- Medical Oncology Division, Ospedale Sacro Cuore di Gesù-Fatebenefratelli, Benevento, Italy
| | - Paola Schiavone
- Medical Oncology Division, "Antonio Perrino" Hospital, Brindisi, Italy
| | | | - Chiara Caliolo
- Medical Oncology Division, "Antonio Perrino" Hospital, Brindisi, Italy
| | - Dario Loparco
- Medical Oncology Division, "Antonio Perrino" Hospital, Brindisi, Italy
| | | | | | - Saverio Cinieri
- Medical Oncology Division, "Antonio Perrino" Hospital, Brindisi, Italy
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Kong Y, Wei X, Zhang D, Lin H, Peng M, Shang H. Prevention and treatment of anthracycline-induced cardiotoxicity: A bibliometric analysis of the years 2000-2023. Heliyon 2024; 10:e29926. [PMID: 38698971 PMCID: PMC11064157 DOI: 10.1016/j.heliyon.2024.e29926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 03/20/2024] [Accepted: 04/17/2024] [Indexed: 05/05/2024] Open
Abstract
Aims This study aimed to evaluate the global research trend in the prevention and treatment of cardiotoxicity caused by anthracyclines from 2000 to 2023, and to explore international cooperation, research hotspots, and frontier trends. Methods The articles on the prevention and treatment of anthracycline-induced cardiotoxicity published from 2000 to 2023 were searched by Web of Science. The bibliometrics software CiteSpace was used for visual analysis of countries, institutions, journals, authors, cited authors, cited references, and keywords. Results This study analyzed the current status of global research on the prevention and treatment of cardiotoxicity caused by anthracyclines. A total of 3,669 papers were searched and 851 studies were included. The number of publications increased gradually throughout the years. Cardiovascular Toxicology (15) is the journal with the most publications. Circulation (547) ranked first among cited journals. In this field, the country with the most publications is the United States (229), and the institution with the most publications is Charles Univ Prague (18). In the analysis of the authors, Tomas S (10) ranked first. Cardinale D (262) ranked first among cited authors. In the ranking of cited literature frequency, the article ranked first is "Early detection of anthracycline cardiotoxicity and improvement with heart failure therapy" (121). The keywords "heart failure" (215) and "oxidative stress" (212) were the most frequent. "Enalapril", "inflammation", "cell death", "NF-κB" and "Nrf2" were the advanced research contents in 2019-2023. Conclusions This study provided valuable information for cardio-oncology researchers to identify potential collaborators and institutions, discover hot topics, and explore new research directions. The prevention and treatment of anthracycline-induced cardiotoxicity focuses on early detection and timely treatment. The results of the current clinical studies on the treatment of anthracycline-induced cardiotoxicity are contradictory, and more studies are needed to provide more reliable clinical evidence in the future.
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Affiliation(s)
- Yifan Kong
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaohong Wei
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Di Zhang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Hongyuan Lin
- College of Integrated Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, China
| | | | - Hongcai Shang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- College of Integrated Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, China
- Weifang Medical University, Weifang, China
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Kücük P, Abbey L, Schmitt J, Henninger C, Fritz G. Cardiomyocytes, cardiac endothelial cells and fibroblasts contribute to anthracycline-induced cardiac injury through RAS-homologous small GTPases RAC1 and CDC42. Pharmacol Res 2024; 203:107165. [PMID: 38561112 DOI: 10.1016/j.phrs.2024.107165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/01/2024] [Accepted: 03/29/2024] [Indexed: 04/04/2024]
Abstract
The clinical use of the DNA damaging anticancer drug doxorubicin (DOX) is limited by irreversible cardiotoxicity, which depends on the cumulative dose. The RAS-homologous (RHO) small GTPase RAC1 contributes to DOX-induced DNA damage formation and cardiotoxicity. However, the pathophysiological relevance of other RHO GTPases than RAC1 and different cardiac cell types (i.e., cardiomyocytes, non-cardiomyocytes) for DOX-triggered cardiac damage is unclear. Employing diverse in vitro and in vivo models, we comparatively investigated the level of DOX-induced DNA damage in cardiomyocytes versus non-cardiomyocytes (endothelial cells and fibroblasts), in the presence or absence of selected RHO GTPase inhibitors. Non-cardiomyocytes exhibited the highest number of DOX-induced DNA double-strand breaks (DSB), which were efficiently repaired in vitro. By contrast, rather low levels of DSB were formed in cardiomyocytes, which however remained largely unrepaired. Moreover, DOX-induced apoptosis was detected only in non-cardiomyocytes but not in cardiomyocytes. Pharmacological inhibitors of RAC1 and CDC42 most efficiently attenuated DOX-induced DNA damage in all cell types examined in vitro. Consistently, immunohistochemical analyses revealed that the RAC1 inhibitor NSC23766 and the pan-RHO GTPase inhibitor lovastatin reduced the level of DOX-induced residual DNA damage in both cardiomyocytes and non-cardiomyocytes in vivo. Overall, we conclude that endothelial cells, fibroblasts and cardiomyocytes contribute to the pathophysiology of DOX-induced cardiotoxicity, with RAC1- and CDC42-regulated signaling pathways being especially relevant for DOX-stimulated DSB formation and DNA damage response (DDR) activation. Hence, we suggest dual targeting of RAC1/CDC42-dependent mechanisms in multiple cardiac cell types to mitigate DNA damage-dependent cardiac injury evoked by DOX-based anticancer therapy.
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Affiliation(s)
- Pelin Kücük
- Institute of Toxicology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Moorenstrasse 5, Düsseldorf 40225, Germany.
| | - Lena Abbey
- Institute of Toxicology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Moorenstrasse 5, Düsseldorf 40225, Germany
| | - Joachim Schmitt
- Institute of Pharmacology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Moorenstrasse 5, Düsseldorf 40225, Germany
| | - Christian Henninger
- Institute of Toxicology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Moorenstrasse 5, Düsseldorf 40225, Germany
| | - Gerhard Fritz
- Institute of Toxicology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Moorenstrasse 5, Düsseldorf 40225, Germany.
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Musella F, Librera M, Sibilio G, Boccalatte M, Tagliamonte G, Cavaglià E, Ferrara I, Puglia M, Dell'Aversana S, Ducci CB, Dellegrottaglie S, Savarese G, Scatteia A. Cardiovascular magnetic resonance parametric techniques to characterize myocardial effects of anthracycline therapy in adults with normal left ventricular ejection fraction: a systematic review and meta-analysis. Curr Probl Cardiol 2024; 49:102609. [PMID: 38697332 DOI: 10.1016/j.cpcardiol.2024.102609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 04/28/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND The cardiotoxic effects of anthracyclines therapy are well recognized, both in the short and long term. Echocardiography allows monitoring of cancer patients treated with this class of drugs by serial assessment of left ventricle ejection fraction (LVEF) as a surrogate of systolic function. However, changes in myocardial function may occur late in the process when cardiac damage is already established. Novel cardiac magnetic resonance (CMR) parametric techniques, like native T1 mapping and extra-cellular volume (ECV), may detect subclinical myocardial damage in these patients, recognizing early signs of cardiotoxicity before development of overt cancer therapy-related cardiac dysfunction (CTRCD) and prompting tailored therapeutic and follow-up strategies to improve outcome. METHODS AND RESULTS We conducted a systematic review and a meta-analysis to investigate the difference in CMR derived native T1 relaxation time and ECV values, respectively, in anthracyclines-treated cancer patients with preserved EF versus healthy controls. PubMed, Embase, Web of Science and Cochrane Central were searched for relevant studies. A total of 6 studies were retrieved from 1057 publications, of which, four studies with 547 patients were included in the systematic review on T1 mapping and five studies with 481 patients were included in the meta-analysis on ECV. Three out of the four included studies in the systematic review showed higher T1 mapping values in anthracyclines treated patients compared to healthy controls. The meta-analysis demonstrated no statistically significant difference in ECV values between the two groups in the main analysis (Hedges´s g =3.20, 95% CI -0.72-7.12, p =0.11, I2 =99%), while ECV was significantly higher in the anthracyclines-treated group when sensitivity analysis was performed. CONCLUSIONS Higher T1 mapping and ECV values in patients exposed to anthracyclines could represent early biomarkers of CTRCD, able to detect subclinical myocardial changes present before the development of overt myocardial dysfunction. Our results highlight the need for further studies to investigate the correlation between anthracyclines-based chemotherapy and changes in CMR mapping parameters that may guide future tailored follow-up strategies in this group of patients.
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Affiliation(s)
- Francesca Musella
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Cardiology Department, Santa Maria delle Grazie Hospital, Naples, Italy.
| | - Mariateresa Librera
- Cardiac Multi-Imaging Unit, Mediterranea Cardiocentro, Via Orazio 2, 80122 Naples, Italy
| | - Gerolamo Sibilio
- Cardiology Department, Santa Maria delle Grazie Hospital, Naples, Italy
| | - Marco Boccalatte
- Cardiology Department, Santa Maria delle Grazie Hospital, Naples, Italy
| | | | - Enrico Cavaglià
- Radiology Department, Santa Maria delle Grazie Hospital, Naples, Italy
| | - Ilaria Ferrara
- Radiology Department, Santa Maria delle Grazie Hospital, Naples, Italy
| | - Marta Puglia
- Radiology Department, Santa Maria delle Grazie Hospital, Naples, Italy
| | | | | | | | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Heart and Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Alessandra Scatteia
- Advanced Cardiovascular Imaging Unit, Clinica Villa dei Fiori Acerra, Naples, Italy
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Boen HM, Alaerts M, Goovaerts I, Saenen JB, Franssen C, Vorlat A, Vermeulen T, Heidbuchel H, Van Laer L, Loeys B, Van Craenenbroeck EM. Variants in structural cardiac genes in patients with cancer therapy-related cardiac dysfunction after anthracycline chemotherapy: a case control study. Cardiooncology 2024; 10:26. [PMID: 38689299 PMCID: PMC11059765 DOI: 10.1186/s40959-024-00231-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/23/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Variants in cardiomyopathy genes have been identified in patients with cancer therapy-related cardiac dysfunction (CTRCD), suggesting a genetic predisposition for the development of CTRCD. The diagnostic yield of genetic testing in a CTRCD population compared to a cardiomyopathy patient cohort is not yet known and information on which genes should be assessed in this population is lacking. METHODS We retrospectively included 46 cancer patients with a history of anthracycline induced CTRCD (defined as a decrease in left ventricular ejection fraction (LVEF) to < 50% and a ≥ 10% reduction from baseline by echocardiography). Genetic testing was performed for 59 established cardiomyopathy genes. Only variants of uncertain significance and (likely) pathogenic variants were included. Diagnostic yield of genetic testing was compared with a matched cohort of patients with dilated cardiomyopathy (DCM, n = 46) and a matched cohort of patients without cardiac disease (n = 111). RESULTS Average LVEF at time of CTRCD diagnosis was 30.1 ± 11.0%. Patients were 52.9 ± 14.6 years old at time of diagnosis and 30 (65.2%) were female. Most patients were treated for breast cancer or lymphoma, with a median doxorubicin equivalent dose of 300 mg/m2 [112.5-540.0]. A genetic variant, either pathogenic, likely pathogenic or of uncertain significance, was identified in 29/46 (63.0%) of patients with CTRCD, which is similar to the DCM cohort (34/46, 73.9%, p = 0.262), but significantly higher than in the negative control cohort (47/111, 39.6%, p = 0.018). Variants in TTN were the most prevalent in the CTRCD cohort (43% of all variants). All (likely) pathogenic variants identified in the CTRCD cohort were truncating variants in TTN. There were no significant differences in severity of CTRCD and in recovery rate in variant-harbouring individuals versus non-variant harbouring individuals. CONCLUSIONS In this case-control study, cancer patients with anthracycline-induced CTRCD have an increased burden of genetic variants in cardiomyopathy genes, similar to a DCM cohort. If validated in larger prospective studies, integration of genetic data in risk prediction models for CTRCD may guide cancer treatment. Moreover, genetic results have important clinical impact, both for the patient in the setting of precision medicine, as for the family members that will receive genetic counselling.
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Affiliation(s)
- Hanne M Boen
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Antwerp, Belgium.
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium.
| | - Maaike Alaerts
- Centrum of Medical Genetics, GENCOR, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Inge Goovaerts
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Centrum of Medical Genetics, GENCOR, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Johan B Saenen
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
| | - Constantijn Franssen
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
| | - Anne Vorlat
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
| | - Tom Vermeulen
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Antwerp, Belgium
| | - Hein Heidbuchel
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
| | - Lut Van Laer
- Centrum of Medical Genetics, GENCOR, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Bart Loeys
- Centrum of Medical Genetics, GENCOR, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Emeline M Van Craenenbroeck
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
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Hwang HJ, Han SA, Sohn IS. Breast Cancer and Therapy-Related Cardiovascular Toxicity. J Breast Cancer 2024; 27:27.e16. [PMID: 38769686 DOI: 10.4048/jbc.2024.0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 04/10/2024] [Accepted: 04/23/2024] [Indexed: 05/22/2024] Open
Abstract
The global incidence of breast cancer is on the rise, a trend also observed in South Korea. However, thanks to the rapid advancements in anticancer therapies, survival rates are improving. Consequently, post-treatment health and quality of life for breast cancer survivors are emerging as significant concerns, particularly regarding treatment-related cardiotoxicity. In this review, we delve into the cardiovascular complications associated with breast cancer treatment, explore surveillance protocols for early detection and diagnosis of late complications, and discuss protective strategies against cardiotoxicity in breast cancer patients undergoing anticancer therapy, drawing from multiple guidelines.
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Affiliation(s)
- Hui-Jeong Hwang
- Department of Cardiology, Kyung Hee University College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Sang-Ah Han
- Department of Surgery, Kyung Hee University College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Il Suk Sohn
- Department of Cardiology, Kyung Hee University College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
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Inoue K, Machino-Ohtsuka T, Nakazawa Y, Iida N, Sasamura R, Bando H, Chiba S, Tasaka N, Ishizu T, Murakoshi N, Xu D, Sekine I, Tajiri K. Early Detection and Prediction of Anthracycline-Induced Cardiotoxicity - A Prospective Cohort Study. Circ J 2024; 88:751-759. [PMID: 38462534 DOI: 10.1253/circj.cj-24-0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
BACKGROUND In the present study, we aimed to investigate whether early cardiac biomarker alterations and echocardiographic parameters, including left atrial (LA) strain, can predict anthracycline-induced cardiotoxicity (AIC) and thus develop a predictive risk score.Methods and Results: The AIC registry is a prospective, observational cohort study designed to gather serial echocardiographic and biomarker data before and after anthracycline chemotherapy. Cardiotoxicity was defined as a reduction in left ventricular ejection fraction (LVEF) ≥10 percentage points from baseline and <55%. In total, 383 patients (93% women; median age, 57 [46-66] years) completed the 2-year follow-up; 42 (11.0%) patients developed cardiotoxicity (median time to onset, 292 [175-440] days). Increases in cardiac troponin T (TnT) and B-type natriuretic peptide (BNP) and relative reductions in the left ventricular global longitudinal strain (LV GLS) and LA reservoir strain [LASr] at 3 months after anthracycline administration were independently associated with subsequent cardiotoxicity. A risk score containing 2 clinical variables (smoking and prior cardiovascular disease), 2 cardiac biomarkers at 3 months (TnT ≥0.019 ng/mL and BNP ≥31.1 pg/mL), 2 echocardiographic variables at 3 months (relative declines in LV GLS [≥6.5%], and LASr [≥7.5%]) was generated. CONCLUSIONS Early decline in LASr was independently associated with subsequent cardiotoxicity. The AIC risk score may provide useful prognostication in patients receiving anthracyclines.
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Affiliation(s)
- Keiko Inoue
- Department of Cardiology, Institute of Medicine, University of Tsukuba
| | | | - Yoko Nakazawa
- Department of Cardiology, Mito Kyodo General Hospital
| | - Noriko Iida
- Clinical Laboratory, Tsuchiura Kyodo General Hospital
| | | | - Hiroko Bando
- Department of Breast and Endocrine Surgery, Institute of Medicine, University of Tsukuba
| | - Shigeru Chiba
- Department of Hematology, Institute of Medicine, University of Tsukuba
| | - Nobutaka Tasaka
- Department of Obstetrics and Gynecology, Institute of Medicine, University of Tsukuba
| | - Tomoko Ishizu
- Tsukuba Life Science Innovation Program (T-LSI), School of Integrative and Global Majors (SIGMA), University of Tsukuba
| | | | - Dongzhu Xu
- Department of Cardiology, Institute of Medicine, University of Tsukuba
- Tsukuba Life Science Innovation Program (T-LSI), School of Integrative and Global Majors (SIGMA), University of Tsukuba
| | - Ikuo Sekine
- Department of Medical Oncology, Institute of Medicine, University of Tsukuba
| | - Kazuko Tajiri
- Tsukuba Life Science Innovation Program (T-LSI), School of Integrative and Global Majors (SIGMA), University of Tsukuba
- Department of Cardiology, National Cancer Center Hospital East
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An Y, Xue L, Xu L, Zhang C, Yang Y, Liu Y, Ma N. Evaluation the Effect of Anthracyclines on Cardiac Function in Children Lymphoma Survivors by Left Ventricular Myocardial Work. Pediatr Cardiol 2024:10.1007/s00246-024-03480-2. [PMID: 38662212 DOI: 10.1007/s00246-024-03480-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 03/20/2024] [Indexed: 04/26/2024]
Abstract
Anthracycline chemotherapy is associated with the left ventricular (LV) dysfunction, but the conventional echocardiographic parameter is insensitive in detecting subclinical cardiac dysfunction, and the role of echocardiography in children cancer survivors (CCSs) has not been well established. Here, the myocardial work (MW) was employed to evaluate the early effect of the anthracyclines on LV function in children lymphoma survivors, as well as to explore the clinical application value of this modality. 51 children lymphoma survivors treated with anthracyclines were included. During the treatments, the echocardiography was performed at baseline (T0 phase), the 3rd (T1 phase) and 6th (T2 phase) chemotherapeutic cycle, respectively. After that, the conventional echocardiographic parameters, LV global longitudinal strain (GLS), and global myocardial work (GMW) parameters were obtained. Finally, these echocardiographic parameters were compared to distinguish the differences among three groups, and correlation analysis was used to identify relationship between GMW parameters and LV GLS. Compared with the baseline, we found that there are no significant differences for LVEF and other conventional echocardiographic parameters after chemotherapy, but the value of LV lateral E/E' increased at T1 and T2 group. The GLS, global work index, global constructed work, and global work efficiency were decreased, while the global wasted work was increased after chemotherapy (all P < 0.05). The correlation analysis showed that the GLS has significant correlation with GMW parameters (all P < 0.001). The MW, as a new noninvasive echocardiography modality, could be used to quantitatively evaluate the LV MW in children lymphoma survivors treated with anthracyclines, which providing a sensitive method to early detect the children's LV dysfunction after the chemotherapy.
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Affiliation(s)
- Yuqiong An
- Heart Center, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, 56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Li Xue
- Heart Center, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, 56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Liyuan Xu
- Heart Center, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, 56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Chao Zhang
- Heart Center, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, 56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Yijie Yang
- Heart Center, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, 56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Yong Liu
- Department of Ultrasound, Beijing-Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Ning Ma
- Heart Center, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, 56 Nanlishi Road, Xicheng District, Beijing, 100045, China.
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9
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Felix N, Nogueira PC, Silva IM, Costa TA, Campello CA, Stecca C, Lopes RD. Cardio-protective effects of statins in patients undergoing anthracycline-based chemotherapy: An updated meta-analysis of randomized controlled trials. Eur J Intern Med 2024:S0953-6205(24)00164-X. [PMID: 38643042 DOI: 10.1016/j.ejim.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 03/28/2024] [Accepted: 04/10/2024] [Indexed: 04/22/2024]
Abstract
INTRODUCTION Several interventions have been tested for cardio-protection against anthracycline-induced cancer therapy-related cardiovascular dysfunction (CTRCD). The role of statins in this setting remains unclear. METHODS We systematically searched PubMed, Embase, Cochrane Library, Clinicaltrials.gov, and Web of Science for randomized controlled trials (RCTs) comparing statins versus control (placebo or no intervention) for preventing anthracycline-induced CTRCD. We applied a random-effects model to pool risk ratios (RR) and mean differences (MD) with 95 % confidence intervals (CI). RESULTS We included seven RCTs comprising 887 patients with planned chemotherapy with anthracycline-based regimens, of whom 49.8 % were randomized to statins. Relative to placebo, statins significantly reduced the incidence of cardiotoxicity/CTRCD (RR 0.46; 95 % CI 0.29 to 0.72; p < 0.001). The left ventricular end-systolic volume was also lower in patients treated with statin (MD -3.12 mL; 95 % CI -6.13 to -0.12 mL; p = 0.042). There was no significant difference between groups in post-anthracycline left ventricular ejection fraction (LVEF) overall. CONCLUSION In this meta-analysis of RCTs, statins were significantly associated with a lower incidence of anthracycline-induced CTRCD and attenuated changes in the left ventricular end-systolic volume. Thus, our findings suggest that statins should be considered as a cardio-protection strategy for patients with planned anthracycline-based chemotherapy.
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Affiliation(s)
- Nicole Felix
- Federal University of Campina Grande, Campina Grande, Brazil
| | - Paula C Nogueira
- Hospital da Mulher, São Paulo, Brazil; Grupo Fleury, São Paulo, Brazil.
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10
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Michel L, Rassaf T. [Heart and cancer: cardio-oncology]. Herz 2024; 49:111-117. [PMID: 38289420 DOI: 10.1007/s00059-024-05232-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 03/07/2024]
Abstract
Cardiovascular diseases and cancer have a complex relationship and show a reciprocal linkage and influence. Mutual risk factors, demographic changes and increasing multimorbidity result in an increase in the incidence of both diseases. Advances in oncological and cardiological treatment lead to a further increase in patients with cured or chronic diseases as a relevant comorbidity. The induction of cardiovascular side effects by cancer therapies leads to increased cardiovascular morbidity and mortality in cancer patients. Recent data also show that cardiovascular disease, through various factors, can also promote the development and progression of cancer. An understanding of the interrelationship between cardiovascular diseases and cancer can be seen as a major medical challenge for the future. To this end, scientific, structural, clinical and educational interfaces between cardiology and oncology are essential. This article outlines the complex relationships between cardiovascular diseases and cancer and defines current and future challenges for the best possible care of affected patients.
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Affiliation(s)
- Lars Michel
- Klinik für Kardiologie und Angiologie, Westdeutsches Herz- und Gefäßzentrum, Universitätsklinikum Essen, Hufelandstraße 55, 45147, Essen, Deutschland
| | - Tienush Rassaf
- Klinik für Kardiologie und Angiologie, Westdeutsches Herz- und Gefäßzentrum, Universitätsklinikum Essen, Hufelandstraße 55, 45147, Essen, Deutschland.
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11
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Vafa RG, Sabahizadeh A, Mofarrah R. Guarding the heart: How SGLT-2 inhibitors protect against chemotherapy-induced cardiotoxicity: SGLT-2 inhibitors and chemotherapy-induced cardiotoxicity. Curr Probl Cardiol 2024; 49:102350. [PMID: 38128634 DOI: 10.1016/j.cpcardiol.2023.102350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023]
Abstract
The introduction of chemotherapy agents has significantly transformed cancer treatment, with anthracyclines being one of the most commonly used drugs. While these agents have proven to be highly effective against various types of cancers, they come with complications, including neurotoxicity, nephrotoxicity, and cardiotoxicity. Among these side effects, cardiotoxicity is the leading cause of morbidity and mortality, with anthracyclines being the primary culprit. Chemotherapy medications have various mechanisms that can lead to cardiac injury. Hence, numerous studies have been conducted to decrease the cardiotoxicity of these treatments. Combination therapy with beta-blockers, Angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers have effectively reduced such outcomes. However, a definitive preventive strategy is yet to be established. Meanwhile, sodium-glucose co-transporter-2 (SGLT-2) inhibitors lower blood glucose levels in type 2 diabetes by reducing its re-absorption in the kidneys. They are thus considered potent drugs for glycemic control and reduction of cardiovascular risks. Recent studies have shown that SGLT-2 inhibitors are crucial in preventing chemotherapy-induced cardiotoxicity. They enhance heart cell viability, prevent degenerative changes, stimulate autophagy, and reduce cell death. This drug class also reduces inflammation by inhibiting reactive oxygen species and inflammatory cytokine production. Moreover, it can not only reverse the harmful effects of anticancer agents on the heart structure but also enhance the effectiveness of chemotherapy by minimizing potential consequences on the heart. In conclusion, SGLT-2 inhibitors hold promise as a therapeutic strategy for protecting cancer patients from chemotherapy-induced heart damage and improving cardiovascular outcomes.
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Ibrahim AA, Nsairat H, Al-Sulaibi M, El-Tanani M, Jaber AM, Lafi Z, Barakat R, Abuarqoub DA, Mahmoud IS, Obare SO, Aljabali AAA, Alkilany AM, Alshaer W. Doxorubicin conjugates: a practical approach for its cardiotoxicity alleviation. Expert Opin Drug Deliv 2024; 21:399-422. [PMID: 38623735 DOI: 10.1080/17425247.2024.2343882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/29/2024] [Indexed: 04/17/2024]
Abstract
INTRODUCTION Doxorubicin (DOX) emerges as a cornerstone in the arsenal of potent chemotherapeutic agents. Yet, the clinical deployment of DOX is tarnished by its proclivity to induce severe cardiotoxic effects, culminating in heart failure and other consequential morbidities. In response, a panoply of strategies has undergone rigorous exploration over recent decades, all aimed at attenuating DOX's cardiotoxic impact. The advent of encapsulating DOX within lipidic or polymeric nanocarriers has yielded a dual triumph, augmenting DOX's therapeutic efficacy while mitigating its deleterious side effects. AREAS COVERED Recent strides have spotlighted the emergence of DOX conjugates as particularly auspicious avenues for ameliorating DOX-induced cardiotoxicity. These conjugates entail the fusion of DOX through physical or chemical bonds with diminutive natural or synthetic moieties, polymers, biomolecules, and nanoparticles. This spectrum encompasses interventions that impinge upon DOX's cardiotoxic mechanism, modulate cellular uptake and localization, confer antioxidative properties, or refine cellular targeting. EXPERT OPINION The endorsement of DOX conjugates as a compelling stratagem to mitigate DOX-induced cardiotoxicity resounds from this exegesis, amplifying safety margins and the therapeutic profile of this venerated chemotherapeutic agent. Within this ambit, DOX conjugates stand as a beacon of promise in the perpetual pursuit of refining chemotherapy-induced cardiac compromise.
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Affiliation(s)
- Abed Alqader Ibrahim
- Department of Nanoscience, Joint School of Nanoscience and Nanoengineering, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Hamdi Nsairat
- Pharmacological and Diagnostic Research Center, Faculty of Pharmacy, Al-Ahliyya Amman University, Amman, Jordan
| | - Mazen Al-Sulaibi
- Pharmacological and Diagnostic Research Center, Faculty of Pharmacy, Al-Ahliyya Amman University, Amman, Jordan
| | - Mohamed El-Tanani
- Pharmacological and Diagnostic Research Center, Faculty of Pharmacy, Al-Ahliyya Amman University, Amman, Jordan
- College of Pharmacy, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates
| | - Areej M Jaber
- Pharmacological and Diagnostic Research Center, Faculty of Pharmacy, Al-Ahliyya Amman University, Amman, Jordan
| | - Zainab Lafi
- Pharmacological and Diagnostic Research Center, Faculty of Pharmacy, Al-Ahliyya Amman University, Amman, Jordan
| | - Rahmeh Barakat
- Pharmacological and Diagnostic Research Center, Faculty of Pharmacy, Al-Ahliyya Amman University, Amman, Jordan
| | - Duaa Azmi Abuarqoub
- Department of Pharmacology and Biomedical Sciences, Faculty of Pharmacy and Medical Sciences, University of Petra, Amman, Jordan
- Cell Therapy Center, The University of Jordan, Amman, Jordan
| | - Ismail Sami Mahmoud
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa, Jordan
| | - Sherine O Obare
- Department of Nanoscience, Joint School of Nanoscience and Nanoengineering, University of North Carolina at Greensboro, Greensboro, NC, USA
- Department of Nanoengineering, Joint School of Nanoscience and Nanoengineering, North Carolina Agricultural and Technical State University, Greensboro, NC, USA
| | - Alaa A A Aljabali
- Faculty of Pharmacy, Department of Pharmaceutical Sciences, Yarmouk University, Irbid, Jordan
| | | | - Walhan Alshaer
- Cell Therapy Center, The University of Jordan, Amman, Jordan
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13
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Park YMM, Jung W, Yeo Y, Park SH, Fradley MG, Malapati SJ, Tarun T, Raj V, Lee HS, Naqvi TZ, Henry-Tillman RS, Mehta JL, Schootman M, Amick BC, Han K, Shin DW. Mid- and long-term risk of atrial fibrillation among breast cancer surgery survivors. BMC Med 2024; 22:88. [PMID: 38419017 PMCID: PMC10903065 DOI: 10.1186/s12916-024-03308-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 02/19/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The risk of incident atrial fibrillation (AF) among breast cancer survivors, especially for younger women, and cancer treatment effects on the association remain unclear. This study aimed to investigate the risk of AF among breast cancer survivors and evaluate the association by age group, length of follow-up, and cancer treatment. METHODS Using data from the Korean Health Insurance Service database (2010-2017), 113,232 women newly diagnosed with breast cancer (aged ≥ 18 years) without prior AF history who underwent breast cancer surgery were individually matched 1:5 by birth year to a sample female population without cancer (n = 566,160) (mean[SD] follow-up, 5.1[2.1] years). Sub-distribution hazard ratios (sHRs) and 95% confidence intervals (CIs) considering death as a competing risk were estimated, adjusting for sociodemographic factors and cardiovascular/non-cardiovascular comorbidities. RESULTS BCS had a slightly increased AF risk compared to their cancer-free counterparts (sHR 1.06; 95% CI 1.00-1.13), but the association disappeared over time. Younger BCS (age < 40 years) had more than a 2-fold increase in AF risk (sHR 2.79; 95% CI 1.98-3.94), with the association remaining similar over 5 years of follow-up. The increased risk was not observed among older BCS, especially those aged > 65 years. Use of anthracyclines was associated with increased AF risk among BCS (sHR 1.57; 95% CI 1.28-1.92), which was more robust in younger BCS (sHR 1.94; 95% CI 1.40-2.69 in those aged ≤ 50 years). CONCLUSIONS Our findings suggest that younger BCS had an elevated risk of incident AF, regardless of the length of follow-up. Use of anthracyclines may be associated with increased mid-to-long-term AF risk among BCS.
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Affiliation(s)
- Yong-Moon Mark Park
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Wonyoung Jung
- Department of Family Medicine / Obesity and Metabolic Health Center, College of Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
- Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yohwan Yeo
- Department of Family Medicine, College of Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Republic of Korea
| | - Sang Hyun Park
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Michael G Fradley
- Cardio-Oncology Program, Division of Cardiology, Department of Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sindhu J Malapati
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Division of Medical Oncology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Tushar Tarun
- Division of Cardiology, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Vinay Raj
- Department of Biology & Department of Math and Computer Science, University of Arkansas at Pine Bluff, Pine Bluff, AR, USA
| | - Hong Seok Lee
- Division of Cardiology, Sarver Heart Center, Banner University Medical Group, University of Arizona, Tucson, AZ, USA
| | - Tasneem Z Naqvi
- Division of Echocardiography, Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Ronda S Henry-Tillman
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Division of Breast Surgical Oncology, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jawahar L Mehta
- Division of Cardiology, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mario Schootman
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Benjamin C Amick
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, 369 Sangdo-Ro, Dongjak-Gu, Seoul, 06978, Republic of Korea.
| | - Dong Wook Shin
- Department of Family Medicine and Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea.
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, 06351, Republic of Korea.
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14
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Tikhomirov AS, Sinkevich YB, Dezhenkova LG, Kaluzhny DN, Ilyinsky NS, Borshchevskiy VI, Schols D, Shchekotikhin AE. Synthesis and antitumor activity of cyclopentane-fused anthraquinone derivatives. Eur J Med Chem 2024; 265:116103. [PMID: 38176358 DOI: 10.1016/j.ejmech.2023.116103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/21/2023] [Accepted: 12/25/2023] [Indexed: 01/06/2024]
Abstract
In our pursuit of developing novel analogs of anthracyclines with enhanced antitumor efficacy and safety, we have designed a synthesis scheme for 4,11-dihydroxy-5,10-dioxocyclopenta[b]anthracene-2-carboxamides. These newly synthesized compounds exhibit remarkable antiproliferative potency against various mammalian tumor cell lines, including those expressing activated mechanisms of multidrug resistance. The structure of the diamine moiety in the carboxamide side chain emerges as a critical determinant for anticancer activity and interaction with key targets such as DNA, topoisomerase 1, and ROS induction. Notably, the introduced modification to the doxorubicin structure results in significantly increased lipophilicity, cellular uptake, and preferential distribution in lysosomes. Consequently, while maintaining an impact on anthracyclines targets, these novel derivatives also demonstrate the potential to induce cytotoxicity through pathways associated with lysosomes. In summary, derivatives of cyclic diamines, particularly 3-aminopyrrolidine, can be considered a superior choice compared to aminosugars for incorporation into natural and semi-synthetic anthracyclines or new anthraquinone derivatives, aiming to circumvent efflux-mediated drug resistance.
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Affiliation(s)
- Alexander S Tikhomirov
- Gause Institute of New Antibiotics, 11 B. Pirogovskaya Street, Moscow, 119021, Russian Federation
| | - Yuri B Sinkevich
- Mendeleyev University of Chemical Technology, 9 Miusskaya Square, Moscow, 125047, Russian Federation
| | - Lyubov G Dezhenkova
- Gause Institute of New Antibiotics, 11 B. Pirogovskaya Street, Moscow, 119021, Russian Federation
| | - Dmitry N Kaluzhny
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 32 Vavilov Street, 119991, Moscow, Russian Federation
| | - Nikolay S Ilyinsky
- Research Center for Molecular Mechanisms of Aging and Age-Related Diseases, Moscow Institute of Physics and Technology, Institutskiy Pereulok, 9, Dolgoprudny, 141700, Russian Federation
| | - Valentin I Borshchevskiy
- Research Center for Molecular Mechanisms of Aging and Age-Related Diseases, Moscow Institute of Physics and Technology, Institutskiy Pereulok, 9, Dolgoprudny, 141700, Russian Federation
| | - Dominique Schols
- Rega Institute for Medical Research, K.U. Leuven, 3000, Leuven, Belgium
| | - Andrey E Shchekotikhin
- Gause Institute of New Antibiotics, 11 B. Pirogovskaya Street, Moscow, 119021, Russian Federation.
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15
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Roy S, Lakritz S, Schreiber AR, Kuna EM, Bradley CJ, Kondapalli L, Diamond JR. Major cardiovascular adverse events in older adults with early-stage triple-negative breast cancer treated with adjuvant taxane + anthracycline versus taxane-based chemotherapy regimens: A SEER-medicare study. Eur J Cancer 2024; 196:113426. [PMID: 38000217 DOI: 10.1016/j.ejca.2023.113426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Triple-negative breast cancer (TNBC) is more aggressive as compared to other subtypes of breast cancer with characteristic metastatic patterns and a poor prognosis. The standard of care for early-stage TNBC is historically anthracycline and taxane-based chemotherapy (ATAX). Despite the effectiveness of this regimen, anthracyclines carry a small but important risk of cardiotoxicity, which is specifically a concern in the older population. This study evaluates major adverse cardiovascular events (MACE) in older women with TNBC treated with ATAX compared to taxane-based chemotherapy (TAX). METHODS Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, we identified women aged 66 and older with TNBC diagnosed between 2010 and 2015 (N = 2215). We compared patient and clinical characteristics according to adjuvant chemotherapy regimen (chemotherapy versus no chemotherapy and ATAX versus TAX). Logistic regression was performed to estimate the odds ratios (OR) and 95% confidence intervals (CIs), Kaplan-Meier survival curves were generated to estimate three-year overall survival (OS) and cancer specific survival (CSS). Cox proportional hazards models were used to analyze OS and CSS while controlling for patient and tumor characteristics. MACE was defined as acute myocardial infarction, heart failure, potentially fatal arrhythmia, and cerebral vascular incidence. Few patients experienced a cardiac death and therefore this was excluded in the analysis. RESULTS Of the 2215 patients in our cohort, most patients (n = 1334; 60.26%) received TAX compared to ATAX (n = 881; 39.78%). Patients who received ATAX were not statistically significantly more likely than those who received TAX to experience acute myocardial infarction, cerebral vascular accident (CVA), or potentially fatal arrhythmia when controlling for traditional risk factors. Among patients who experienced MACE, there was no difference in OS or CSS in patients who received TAX vs ATAX. Patients who received ATAX were less likely to develop heart failure than those who received TAX (OR 0.63, 95% CI [0.45-0.88], p < 0.01). Patients who developed MACE and who were > 76 years old had worse OS compared to those who experienced MACE and were age 66-75 years old (HR 1.67, 95% CI [1.07-2.62], p = 0.02). CONCLUSION Among older women with TNBC, receipt of adjuvant chemotherapy with ATAX was not associated with increased risk of major adverse cardiac events. For those who experienced a cardiac event, there was no difference in survival amongst those who received TAX vs ATAX. Other factors including additional chemotherapy toxicities should be investigated as a potential etiology for the inferior OS previously observed with ATAX vs TAX in older women with node negative or 1-3 positive lymph nodes.
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Affiliation(s)
- Savannah Roy
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Stephanie Lakritz
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Anna R Schreiber
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Elizabeth Molina Kuna
- Population Health Shared Resource, University of Colorado Cancer Center, Aurora, CO, USA
| | - Cathy J Bradley
- Department of Health Systems, Management, and Policy, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lavanya Kondapalli
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jennifer R Diamond
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Mekha M, Joshi A, Maniar V, Maheshwari U, Joshi K, Kalaskar P, Sheth S, Kendre P, Morzaria D, Korgavkar R, Pethe C, Dhande S. The Efficacy of Paxman Scalp Cooling System in Preventing Hair Loss in Breast Cancer Patients Receiving Chemotherapy in Western India - Multi-centre Retrospective Cohort Study. Indian J Dermatol 2024; 69:16-23. [PMID: 38572038 PMCID: PMC10986862 DOI: 10.4103/ijd.ijd_345_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
Aim Chemotherapy-induced alopecia (CIA) is the most common side effect of systemic treatment in breast cancer patients. Scalp cooling gained worldwide acceptance in preventing or mitigating CIA in patients undergoing chemotherapy. The objective of this study was to evaluate the efficacy and safety of the Paxman scalp cooling system (PSCS) in Indian breast cancer patients. Materials and Methods This is a multi-centre, retrospective-observational study including patients registered from 1st March, 2019 to 30th April, 2021 undergoing chemotherapy for breast cancer by using PSCS. The primary end-point was the incidence of CIA after completing cycles of chemotherapy. Results A total of 91 female patients were enrolled in the study, with a median age of 53 years (IQR: 44-62 years). The prevention of alopecia (grade 0 and grade I) was seen in 81%, while more than 50% hair loss (grade 2) was seen in 16.48% after completion of treatment. The univariate analysis results showed that CIA was significantly higher in patients who received anthracyclines (OR: 2.69; 95% CI: 1.04-6.958; P = 0.041) and in patients with a post-infusion cooling time of >150 minutes (OR: 8.409; 95% CI: 2.295-30.787; P = 0.001). The incidence of grade 2 (>50% hair loss) alopecia was 81.3% in patients <6 weeks and was 18.8% at >6 weeks of start of chemotherapy (P < 0.0001). No adverse events were reported in 71.4% of patients, and the most common adverse event was headache (18.7%). Conclusion PSCS is an effective and well-tolerated treatment modality for preventing CIA among breast cancer patients undergoing chemotherapy.
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Affiliation(s)
- Mangesh Mekha
- From the Department of Medical Oncology, Mumbai Oncocare Centre, Pune, India
| | - Ashish Joshi
- Department of Medical Oncology, Mumbai Oncocare Centre, Mumbai, India
| | - Vashishth Maniar
- Department of Medical Oncology, Mumbai Oncocare Centre, Mumbai, India
| | - Udip Maheshwari
- Department of Medical Oncology, Mumbai Oncocare Centre, Mumbai, India
| | - Kshitij Joshi
- Department of Medical Oncology, Mumbai Oncocare Centre, Mumbai, India
| | - Pritam Kalaskar
- Department of Medical Oncology, Mumbai Oncocare Centre, Mumbai, India
| | - Smit Sheth
- Department of Medical Oncology, Mumbai Oncocare Centre, Mumbai, India
| | - Pradip Kendre
- Department of Medical Oncology, Mumbai Oncocare Centre, Mumbai, India
| | - Disha Morzaria
- Department of Clinical Research, Mumbai Oncocare Centre, Mumbai, India
| | - Reshma Korgavkar
- Department of Clinical Research, Mumbai Oncocare Centre, Mumbai, India
| | | | - Sonal Dhande
- Department of Medical Oncology, Mumbai Oncocare Centre, Nashik, India
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17
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Shibata T, Nohara S, Morikawa N, Shibao K, Ito S, Shibata R, Toh U, Nagafuji K, Fukami K, Fukumoto Y. Cardiovascular adverse events and prognosis in patients with haematologic malignancies and breast cancer receiving anticancer agents: Kurume-CREO Registry insights. Eur J Prev Cardiol 2023; 30:1941-1949. [PMID: 37352112 DOI: 10.1093/eurjpc/zwad210] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/16/2023] [Accepted: 06/18/2023] [Indexed: 06/25/2023]
Abstract
AIMS Cancer treatment-related cardiovascular toxicity (CTR-CVT) is a growing concern in patients undergoing anticancer therapy. The Heart Failure Association (HFA) and International Cardio-Oncology Society (ICOS) risk assessment tools have been proposed for the baseline cardiovascular (CV) risk stratification of patients with cancer. This study investigated the incidence of CV adverse events in clinical practice, also using the HFA-ICOS risk tool. METHODS AND RESULTS This single-centre, prospective, observational study was conducted at Kurume University Hospital from October 2016 to August 2021, including patients aged ≥20 years with haematologic malignancies or breast cancer who were receiving anticancer agents. Cardiovascular assessments were performed at enrolment and every 6 months until August 2021, with additional assessments for suspected CV adverse events. The primary endpoint was common terminology criteria for adverse events v4.0 Grade ≥2, and the secondary endpoints were all-cause and CV deaths. Of the enrolled 486 patients, CV adverse events occurred in 24.5, 15.8, 38.1, and 18.0% of patients with leukaemia, malignant lymphoma, multiple myeloma, and breast cancer, respectively. Patients at high or very high risk had a significantly higher incidence of CV events, according to the HFA-ICOS risk tool. Cardiovascular death occurred in 4 (0.8%) patients during follow-up. CONCLUSION This study revealed that 16-38% of patients with haematologic malignancies and breast cancer developed CTR-CVT during follow-up, in which patients with high/very high risk were well predicted by the HFA-ICOS risk assessment tool. Monitoring and managing CV risk factors are essential for safe cancer therapy.
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Affiliation(s)
- Tatsuhiro Shibata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan
| | - Shoichiro Nohara
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan
| | - Nagisa Morikawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan
| | - Kodai Shibao
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan
| | - Shinichiro Ito
- Department of Clinical Laboratory Medicine, Kurume University Hospital, Kurume, Japan
| | - Ryo Shibata
- Division of Nephrology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Uhi Toh
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Koji Nagafuji
- Division of Hematology and Oncology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Kei Fukami
- Division of Nephrology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan
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18
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Dos Santos JM, Joiakim A, Putt DA, Scherrer-Crosbie M, Kim H. 14,15-Dihydroxyeicosatrienoic acid, a soluble epoxide hydrolase metabolite in blood, is a predictor of anthracycline-induced cardiotoxicity - a hypothesis generating study. Cardiooncology 2023; 9:47. [PMID: 38102716 PMCID: PMC10722875 DOI: 10.1186/s40959-023-00198-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Early identification of patients susceptible to chemotherapy-induced cardiotoxicity could lead to targeted treatment to reduce cardiac dysfunction. Rats treated with doxorubicin (DOX), a chemotherapeutic agent, have increased cardiac expression of 14,15-dihydroxyeicosatrienoic acid (14,15-DHET), a bioactive lipid implicated in hypertension and coronary artery disease. However, the utility of 14,15-DHET as plasma biomarkers was not defined. The aim of this study is to investigate if levels of 14,15-DHET are an early blood biomarker to predict the subsequent occurrence of cardiotoxicity in cancer patients after chemotherapy. METHODS H9c2 rat cardiomyocytes were treated with DOX (1 μM) for 2 h and levels of 14,15-DHET in cell media was quantified at 2, 6 or 24 h in media after DOX treatment. Similarly, female Sprague-Dawley rats were treated with DOX for two weeks and levels of 14,15-DHET was assessed in plasma at 48 h and 2 weeks after DOX treatment. Changes in brain natriuretic peptide (BNP) mRNA, an early cardiac hypertrophy process, were determined in the H9c2 cells and rat cardiac tissue. Results were confirmed in human subjects by assessment of levels of 14,15-DHET in plasma of breast cancer patients before and after DOX treatment and left ventricular ejection fraction (LVEF), a clinical marker of cardiotoxicity. RESULTS Levels of 14,15-DHET in cell media and rat plasma increased ~ 3-fold and was accompanied with increase in BNP mRNA in H9c2 cells and rat cardiac tissue after DOX treatment. In matched plasma samples from breast cancer patients, levels of 14,15-DHET were increased in patients that developed cardiotoxicity at 3 months before occurrence of LVEF decrease. CONCLUSIONS Together, these results indicate that levels of 14,15-DHET are elevated prior to major changes in cardiac structure and function after exposure to anthracyclines. Increased levels of 14,15-DHET in plasma may be an important clinical biomarker for early detection of anthracycline-induced cardiotoxicity in cancer patients.
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Affiliation(s)
- Julia Matzenbacher Dos Santos
- Detroit R&D, Inc., 2727 2nd Ave, Suite 4113, Detroit, MI, 48201, USA
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Aby Joiakim
- Detroit R&D, Inc., 2727 2nd Ave, Suite 4113, Detroit, MI, 48201, USA
| | - David A Putt
- Detroit R&D, Inc., 2727 2nd Ave, Suite 4113, Detroit, MI, 48201, USA
| | - Marielle Scherrer-Crosbie
- Cardiac Ultrasound Laboratory, Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Hyesook Kim
- Detroit R&D, Inc., 2727 2nd Ave, Suite 4113, Detroit, MI, 48201, USA.
- Institute of Environmental Health Sciences, Wayne State University, Detroit, MI, 48202, USA.
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19
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Piska K, Koczurkiewicz-Adamczyk P, Jamrozik M, Bucki A, Kołaczkowski M, Pękala E. Comparative study on ABCB1-dependent efflux of anthracyclines and their metabolites: consequences for cancer resistance. Xenobiotica 2023; 53:507-514. [PMID: 37753851 DOI: 10.1080/00498254.2023.2264391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/25/2023] [Indexed: 09/28/2023]
Abstract
1. ABCB1 (P-glycoprotein, MDR1) is one of the most important transporter involved in cancer multi-drug resistance. It also plays a significant role in cancer resistance against anthracyclines, an anticancer group of drugs, including doxorubicin and daunorubicin. Several intracellular enzymes metabolise anthracyclines to carbonyl-reduced, hydroxy metabolites, which have impaired cytotoxic properties. However, metabolite efflux by ABCB1 transporter is not well characterised, while it may be the mechanism responsible for the metabolites' lack of activity.2. In this study recombinant ABCB1 ATPase transporter assay; anthracyclines accumulation assay in resistant cells overexpressing ABCB1; and molecular modelling were used to investigate anthracyclines: doxorubicin and daunorubicin and their carbonyl-reduced metabolites (doxorubicinol, daunorubicinol) susceptibility for ABCB1-dependent efflux.3. Based on the kinetics parameters of ATPase activity of ABCB1, it was found that daunorubicinol exerted an exceptionally high potential for being effluxed by the ABCB1 transporter. ABCB1 significantly affected the accumulation pattern of studied chemicals in resistant cancer cells. Doxorubicin and daunorubicinol accumulation were influenced by the activity of ABCB1 modulator - valspodar.4. Results indicate that ABCB1 activity affects not only anthracyclines but also their metabolites. Therefore crosstalk between the process of anthracyclines metabolism and metabolite efflux may be the mechanism of impairing anticancer properties of anthracyclines metabolites.
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Affiliation(s)
- Kamil Piska
- Department of Pharmaceutical Biochemistry, Faculty of Pharmacy, Jagiellonian University Medical College, Kraków, Poland
| | | | - Marek Jamrozik
- Department of Medicinal Chemistry, Faculty of Pharmacy, Jagiellonian University Medical College, Kraków, Poland
| | - Adam Bucki
- Department of Medicinal Chemistry, Faculty of Pharmacy, Jagiellonian University Medical College, Kraków, Poland
| | - Marcin Kołaczkowski
- Department of Medicinal Chemistry, Faculty of Pharmacy, Jagiellonian University Medical College, Kraków, Poland
| | - Elżbieta Pękala
- Department of Pharmaceutical Biochemistry, Faculty of Pharmacy, Jagiellonian University Medical College, Kraków, Poland
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20
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Chatterjee S, Jain CK, Saha T, Roychoudhury S, Majumder HK, Das S. Utilizing coordination chemistry through formation of a Cu II-quinalizarin complex to manipulate cell biology: An in vitro, in silico approach. J Inorg Biochem 2023; 249:112369. [PMID: 37776829 DOI: 10.1016/j.jinorgbio.2023.112369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 10/02/2023]
Abstract
Quinalizarin, an analogue of anthracycline anticancer agents, is an anticancer agent itself. A CuII complex was prepared and characterized by elemental analysis, UV-Vis & IR spectroscopy, mass spectrometry, EPR and DFT. The intention behind the preparation of the complex was to increase cellular uptake, compare its binding with DNA against that of quinalizarin, modulation of semiquinone formation, realization of human DNA topoisomerase I & human DNA topoisomerase II inhibition and observation of anticancer activity. While the first two attributes of complex formation lead to increased efficacy, decrease in semiquinone generation could results in a compromise with efficacy. Inhibition of human DNA topoisomerase makes up this envisaged compromise in free radical activity since the complex shows remarkable ability to disrupt activities of human DNA topoisomerase I and II. The complex unlike quinalizarin, does not catalyze flow of electrons from NADH to O2 to the extent known for quinalizarin. Hence, decrease in semiquinone or superoxide radical anion could make modified quinalizarin [as CuII complex] less efficient in free radical pathway. However, it would be less cardiotoxic and that would be advantageous to qualify it as a better anticancer agent. Although binding to calf thymus DNA was comparable to quinalizarin, it was weaker than anthracyclines. Low cost of quinalizarin could justify consideration as a substitute for anthracyclines but the study revealed IC50 of quinalizarin/CuII-quinalizarin was much higher than anthracyclines or their complexes. Even then, there is a possibility that CuII-quinalizarin could be an improved and less costly form of quinalizarin as anticancer agent.
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Affiliation(s)
- Sayantani Chatterjee
- Department of Chemistry (Inorganic Section), Jadavpur University, Kolkata 700 032, India; Department of Chemistry, Vijaygarh Jyotish Ray College, Kolkata 700 032, India
| | - Chetan Kumar Jain
- Cancer Biology & Inflammatory Disorder Division, Indian Institute of Chemical Biology, Kolkata 700 032, India; Infectious Diseases and Immunology Division, Indian Institute of Chemical Biology, Kolkata 700 032, India
| | - Tanmoy Saha
- Department of Chemistry (Inorganic Section), Jadavpur University, Kolkata 700 032, India
| | - Susanta Roychoudhury
- Cancer Biology & Inflammatory Disorder Division, Indian Institute of Chemical Biology, Kolkata 700 032, India
| | - Hemanta Kumar Majumder
- Infectious Diseases and Immunology Division, Indian Institute of Chemical Biology, Kolkata 700 032, India
| | - Saurabh Das
- Department of Chemistry (Inorganic Section), Jadavpur University, Kolkata 700 032, India.
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21
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Hadžibeganović A, Koprić D. Toxic Cardiomyopathy in a Young Patient Treated for Her2-Positive Early Breast Cancer: Case Report and Literature Review. Acta Med Acad 2023; 52:225-230. [PMID: 38095178 PMCID: PMC10945316 DOI: 10.5644/ama2006-124.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 06/11/2023] [Indexed: 02/27/2024] Open
Abstract
OBJECTIVE We present the case of toxic cardiomyopathy in a healthy thirty-eight-year-old female patient treated for Her2-positive early breast cancer. CASE REPORT During the neoadjuvant treatment, the patient received four cycles of AC regimen and four cycles of docetaxel in combination with trastuzumab biosimilar. Two days after she received the ninth dose of trastuzumab biosimilar, she reported feebleness, palpitation, and dyspnoea. A heart ultrasound was performed and was normal without changes in the ejection fraction (EF) compared to previous checks. Three days later she reports worsening of her symptoms that were highly suggestive of heart failure. A cardiologist was consulted who insisted that the patient's symptoms were the consequence of the disease progression. A CT scan showed signs of heart failure. A heart ultrasound was done and the EF dropped to 30%. Drainage of the right pleural cavity was performed and pharmacotherapy for heart failure was started. The treatment led to clinical improvement, but eighteen months later EF is still not back to normal. CONCLUSION This is a rare case of toxic cardiomyopathy in a young, previously healthy, patient who received anthracyclines followed by trastuzumab biosimilar in combination with taxanes. All the medications this patient received are potentially cardiotoxic. However, the overall presentation is not typical for any of these medications since the patient presented with symptoms and signs of heart failure with significant dilatation of the right atrium, which persists eighteen months after its onset, with only a small increase in the EF. There is also a possibility that the antineoplastic therapy the patient received only facilitated dilatative cardiomyopathy, while the main causative factor was intrinsic or extrinsic.
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Affiliation(s)
| | - Dijana Koprić
- Clinic for Oncology and Radiotherapy, University Clinical Center Tuzla
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22
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D'Amario D, Laborante R, Bianchini E, Galli M, Ciliberti G, Mennuni M, Patti G. Statins as preventive therapy for anthracycline cardiotoxicity: a meta-analysis of randomized controlled trials. Int J Cardiol 2023; 391:131219. [PMID: 37527752 DOI: 10.1016/j.ijcard.2023.131219] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Cardiotoxicity occurs in 5-20% of cancer patients who receive anthracyclines. The aim of this study was to pool all the randomized controlled trials (RCTs) investigating the cardio-protective role of statins in patients treated with anthracyclines. METHODS PubMed and Scopus electronic databases were scanned for eligible studies up to May 3rd, 2023. A total of 5 RCTs with 808 patients were included. Efficacy endpoints were the rate of anthracycline-mediated cardiotoxicity, the incidence of hospitalization for heart failure (HF), left ventricular ejection fraction (LVEF) value after anthracycline treatment, and ∆LVEF calculated as the difference in LVEF before and after anthracycline therapy. Safety endpoints [i.e., the incidence of muscle pain and serious adverse events (SAE)] were also assessed. RESULTS On pooled analysis, the statin-treated group had a lower incidence of cardiotoxicity compared to the placebo group [risk ratio (RR) 0.52, 95% confidence Interval (CI) 0.33-0.83, P = 0.01; I2 = 0%], as well as higher mean LVEF [Mean difference (MD) 1.88, 95% CI 0.66-3.1, P < 0.01; I2 = 57.3%)] and a more favorable ∆LVEF during follow-up (MD 2.38, 95% CI -0.03 - +4.79, P = 0.05; I2 = 99%), despite no significant difference in terms of hospitalization for HF and rate of adverse events. Of note, severe heterogeneity affected the analyses for both LVEF and ΔLVEF. CONCLUSIONS The current meta-analysis of all RCTs conducted so far shows an overall beneficial effect of statins on the risk of anthracyclines-induced cardiotoxicity and LVEF preservation. No difference was observed in the rate of HF hospitalization. More powered RCTs are needed to fully investigate the impact of statins on prognosis in patients receiving anthracyclines therapy.
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Affiliation(s)
- Domenico D'Amario
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy; Division of Cardiology, AOU Maggiore della Carità, Novara, Italy.
| | - Renzo Laborante
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Emiliano Bianchini
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Mattia Galli
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Giuseppe Ciliberti
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Marco Mennuni
- Division of Cardiology, AOU Maggiore della Carità, Novara, Italy
| | - Giuseppe Patti
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy; Division of Cardiology, AOU Maggiore della Carità, Novara, Italy
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23
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Jacobs JEJ, Greason G, Mangold KE, Wildiers H, Willems R, Janssens S, Noseworthy P, Lopez-Jimenez F, Voigt JU, Friedman P, Van Aelst L, Vandenberk B, Attia ZI, Herrmann J. Artificial Intelligence ECG as a Novel Screening Tool to Detect a Newly Abnormal Left Ventricular Ejection Fraction After Anthracycline-Based Cancer Therapy. Eur J Prev Cardiol 2023:zwad348. [PMID: 37943680 DOI: 10.1093/eurjpc/zwad348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/15/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
AIM Cardiotoxicity is a serious side effect of anthracycline treatment, most commonly manifesting as a reduction in left ventricular ejection fraction (LVEF). Early recognition and treatment have been advocated, but robust, convenient and cost-effective alternatives to cardiac imaging are missing. Recent developments in artificial intelligence (AI) techniques applied to electrocardiograms (ECGs) may fill this gap, but no study so far has demonstrated its merit for the detection of an abnormal LVEF after anthracycline therapy. METHODS Single center consecutive cohort study of all breast cancer patients with ECG and transthoracic echocardiography (TTE) evaluation before and after (neo)adjuvant anthracycline chemotherapy. Patients with HER-2-directed therapy, metastatic disease, second primary malignancy or pre-existing cardiovascular disease were excluded from the analyses as were patients with LVEF decline for reasons other than anthracycline-induced cardiotoxicity. Primary readout was the diagnostic performance of AI-ECG by area under the curve (AUC) for LVEFs <50%. RESULTS Of 989 consecutive female breast cancer patients, 22 developed a decline in LVEF attributed to anthracycline therapy over a follow-up time of 9.83 ± 4.2 years. After exclusion of patients who did not have an ECGs within 90 days of a TTE, 20 cases and 683 controls remained. The AI-ECG model detected an LVEF <50% and ≤35% after anthracycline therapy with an AUC of 0.93 and 0.94, respectively. CONCLUSIONS These data support the use of AI-ECG for cardiotoxicity screening after anthracycline-based chemotherapy. This technology could serve as a gatekeeper to more costly cardiac imaging and could enable patients to monitor themselves over long periods of time.
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Affiliation(s)
- Johanna E J Jacobs
- Department of Cardiovascular diseases, Mayo Clinic, Rochester, MN, USA
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Grace Greason
- Department of Cardiovascular diseases, Mayo Clinic, Rochester, MN, USA
| | - Kathryn E Mangold
- Department of Cardiovascular diseases, Mayo Clinic, Rochester, MN, USA
| | - Hans Wildiers
- Department of Oncology, University Hospitals Leuven, Leuven Belgium
| | - Rik Willems
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Stefan Janssens
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Peter Noseworthy
- Department of Cardiovascular diseases, Mayo Clinic, Rochester, MN, USA
| | | | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Paul Friedman
- Department of Cardiovascular diseases, Mayo Clinic, Rochester, MN, USA
| | - Lucas Van Aelst
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Bert Vandenberk
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | | | - Joerg Herrmann
- Department of Cardiovascular diseases, Mayo Clinic, Rochester, MN, USA
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24
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Kelbert M, Daronch NA, Pereira CS, Cesca K, Michels C, Soares HM. Inhibitory impact of the anticancer drug doxorubicin on anaerobic microbial community. Aquat Toxicol 2023; 264:106706. [PMID: 37837867 DOI: 10.1016/j.aquatox.2023.106706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/01/2023] [Accepted: 09/24/2023] [Indexed: 10/16/2023]
Abstract
The inhibitory effect of the anticancer drug doxorubicin (DOX) on biogas production was evaluated in short-term and long-term exposure assays. The short-term assays reached the DOX IC50 value on 648 ± 50 µg·L-1. In addition, it was found that inhibition caused by the exposure of 10×103 µg·L-1 was reversible after removing DOX from the feeding synthetic medium. Furthermore, DOX can be rapidly sorbed by the biomass (despite the low Kow), which might contribute to the inhibitory effect. The results of long-term exposure assays, when the DOX volumetric loading rate was increased from 100 µgDOX·L-1·day-1 to 200 µgDOX·L-1·day-1, showed that biogas production and COD removal decreased rapidly. However, the methanogenic Archaeas could recover from this exposure, corroborating the results on short-term exposure assays. In conclusion, DOX can play a key role in inhibiting biological wastewater treatment processes if its concentration in hospital wastewater treatment plants increases abruptly.
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Affiliation(s)
- Maikon Kelbert
- Department of Chemical and Food Engineering, Federal University of Santa Catarina, Florianópolis, SC 88040-900, Brazil.
| | - Naionara Ariete Daronch
- Department of Chemical and Food Engineering, Federal University of Santa Catarina, Florianópolis, SC 88040-900, Brazil
| | - Camila Senna Pereira
- Department of Chemical and Food Engineering, Federal University of Santa Catarina, Florianópolis, SC 88040-900, Brazil
| | - Karina Cesca
- Department of Chemical and Food Engineering, Federal University of Santa Catarina, Florianópolis, SC 88040-900, Brazil
| | - Camila Michels
- Department of Chemical and Food Engineering, Federal University of Santa Catarina, Florianópolis, SC 88040-900, Brazil
| | - Hugo Moreira Soares
- Department of Chemical and Food Engineering, Federal University of Santa Catarina, Florianópolis, SC 88040-900, Brazil
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25
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Łopuszyński W, Brzana A, Szczubiał M, Bulak K, Śmiech A. Topoisomerase IIα immunoexpression in feline mammary carcinomas: A correlation with Ki67 immunoexpression and the mitotic count. Res Vet Sci 2023; 164:104992. [PMID: 37657395 DOI: 10.1016/j.rvsc.2023.104992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/07/2023] [Accepted: 08/23/2023] [Indexed: 09/03/2023]
Abstract
The aim of the study was to compare the immunohistochemical expression of topoisomerase IIα protein (Topo IIα) with Ki67 expression and mitotic count in feline mammary carcinomas (FMCs). Topo IIα is considered as a proliferation indicator as well as a molecular target of anthracycline chemotherapy. The studied material included 70 FMCs from female cats treated with mastectomy. Primary mouse monoclonal antibodies directed against Topo IIα and Ki67 were used in immunohistochemical reactions. The number of mitotic figures was counted at 400× magnification in a field of 2.37 mm2. Immunohistochemical reaction for Topo IIα occurred in cell nuclei. The Topo IIα index ranged from 6.12% to 54.60% and was positively correlated with the values of the Ki67 index (r = 0.7193) and the mitotic count (r = 0. 2858). This indicates the potential possibility of use of the immunohistochemical expression of Topo IIα to assess the rate of proliferation in FMCs. The wide range of expression of Topo IIα in individual tumorus found in the conducted studies allows us to hypothesize that its assessment could be used as a predictive marker in chemotherapy of FMCs with the use of anthracyclines. However, this requires confirmation in clinical trials.
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Affiliation(s)
- Wojciech Łopuszyński
- Department of Pathomorphology and Forensic Veterinary Medicine, University of Life Sciences, Lublin, Poland.
| | - Adam Brzana
- Regional Veterinary Inspectorate in Opole, Regional Veterinary Laboratory, Opole, Poland
| | - Marek Szczubiał
- Department and Clinic of Animal Reproduction, University of Life Sciences, Lublin, Poland
| | - Kamila Bulak
- Department of Pathomorphology and Forensic Veterinary Medicine, University of Life Sciences, Lublin, Poland
| | - Anna Śmiech
- Department of Pathomorphology and Forensic Veterinary Medicine, University of Life Sciences, Lublin, Poland
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Mattioli R, Ilari A, Colotti B, Mosca L, Fazi F, Colotti G. Doxorubicin and other anthracyclines in cancers: Activity, chemoresistance and its overcoming. Mol Aspects Med 2023; 93:101205. [PMID: 37515939 DOI: 10.1016/j.mam.2023.101205] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/15/2023] [Accepted: 07/17/2023] [Indexed: 07/31/2023]
Abstract
Anthracyclines have been important and effective treatments against a number of cancers since their discovery. However, their use in therapy has been complicated by severe side effects and toxicity that occur during or after treatment, including cardiotoxicity. The mode of action of anthracyclines is complex, with several mechanisms proposed. It is possible that their high toxicity is due to the large set of processes involved in anthracycline action. The development of resistance is a major barrier to successful treatment when using anthracyclines. This resistance is based on a series of mechanisms that have been studied and addressed in recent years. This work provides an overview of the anthracyclines used in cancer therapy. It discusses their mechanisms of activity, toxicity, and chemoresistance, as well as the approaches used to improve their activity, decrease their toxicity, and overcome resistance.
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Affiliation(s)
- Roberto Mattioli
- Dept. Biochemical Sciences A. Rossi Fanelli, Sapienza University of Rome, Rome, Italy
| | - Andrea Ilari
- Institute of Molecular Biology and Pathology, Italian National Research Council IBPM-CNR, Rome, Italy
| | - Beatrice Colotti
- Dept. Biochemical Sciences A. Rossi Fanelli, Sapienza University of Rome, Rome, Italy
| | - Luciana Mosca
- Dept. Biochemical Sciences A. Rossi Fanelli, Sapienza University of Rome, Rome, Italy
| | - Francesco Fazi
- Department of Anatomical, Histological, Forensic & Orthopaedic Sciences, Section of Histology and Medical Embryology, Sapienza University of Rome, Rome, Italy
| | - Gianni Colotti
- Institute of Molecular Biology and Pathology, Italian National Research Council IBPM-CNR, Rome, Italy.
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27
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Stahl M, Giblin G, Liu Y, Winer ES, Garcia JS, Chen E, Wadleigh M, Ling K, Lindsley RC, Shimony S, Copson K, Charles A, DeAngelo DJ, Stone RM, Nohria A, Luskin MR. Incidence and predictors of anthracycline-related left ventricular dysfunction in acute myeloid leukemia. Leuk Res 2023; 132:107351. [PMID: 37451200 DOI: 10.1016/j.leukres.2023.107351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/01/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Anthracycline-related left ventricular dysfunction (ARLVD) is a concern in patients with acute myeloid leukemia (AML) undergoing anthracyclinecontaining induction chemotherapy. However, the incidence of ARLVD in the modern era of routine pretreatment left ventricular ejection fraction (LVEF) echocardiographic assessment, as well as the clinical and genetic predictors of ARLVD are not well understood. METHODS Consecutive adult patients with AML receiving anthracycline-containing induction chemotherapy at the Dana-Farber Cancer Institute from 2014 to 2022 were studied. Inclusion criteria included availability of a pre and post chemotherapy echocardiogram to assess the LVEF, pre-treatment LVEF > 50 %, as well as comprehensive diagnostic next generation sequencing assessing for the presence of myeloid mutations. The primary endpoint was the incidence of ARLVD defined as LVEF < 50 % post-induction. RESULTS Out of 419 patients meeting inclusion criteria, 34 (8%) patients developed ARLVD. Among the 122/419 patients who did not undergo planned allogeneic stem cell transplantation (allo-SCT), ARLVD was the deciding factor for ineligibility in 4 patients (1%). Baseline cardiovascular comorbidities (hypertension, diabetes mellitus, hyperlipidemia, smoking and coronary artery disease) and cumulative anthracycline dose were not predictive of post-induction ARLVD. However, the presence of a JAK2 mutation (but not other myeloid mutations) was associated with an increased risk of ARLVD in multivariable analysis (OR 8.34, 95 % CI 1.55-39.3, p = 0.007). DISCUSSION In a group of AML patients with normal LVEF prior to anthracycline-containing induction chemotherapy, ARLVD was infrequent and did not commonly preclude post-remission allo-SCT consolidation. Genetic predictors of ARLVD require further investigation in a larger patient cohort.
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MESH Headings
- Adult
- Humans
- Anthracyclines/adverse effects
- Stroke Volume
- Incidence
- Ventricular Function, Left
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/chemically induced
- Antibiotics, Antineoplastic/therapeutic use
- Ventricular Dysfunction, Left/chemically induced
- Ventricular Dysfunction, Left/drug therapy
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Affiliation(s)
- Maximilian Stahl
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Gerard Giblin
- Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Yiwen Liu
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Eric S Winer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Jacqueline S Garcia
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Evan Chen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Martha Wadleigh
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Kelly Ling
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - R Coleman Lindsley
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Shai Shimony
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States; Rabin Medical Center and Faculty of Medicine, Tel Aviv University, Israel
| | - Kevin Copson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Anne Charles
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Daniel J DeAngelo
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Richard M Stone
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Anju Nohria
- Department of Cardiology, Brigham and Women's Hospital, Boston, MA, United States
| | - Marlise R Luskin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States.
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Limi DC, Reikvam H. Liposomal drug formulations for treatment of hematological malignancies. Expert Opin Pharmacother 2023; 24:1911-1914. [PMID: 37823599 DOI: 10.1080/14656566.2023.2269086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/06/2023] [Indexed: 10/13/2023]
Affiliation(s)
- Daniel Cacic Limi
- Department of Hematology and Oncology, Stavanger University Hospital, Stavanger, Norway
| | - Håkon Reikvam
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
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29
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Xiu M, Lu Y, Wang X, Fan Y, Li Q, Li Q, Wang JY, Luo Y, Cai RG, Chen SS, Yuan P, Ma F, Xu BH, Zhang P. [Dose-dense paclitaxel plus carboplatin in combination with trastuzumab neoadjuvant versus standard adjuvant therapy in human epidermal growth factor receptor-2 positive and hormone receptor negative breast cancer: a prospective cohort study]. Zhonghua Zhong Liu Za Zhi 2023; 45:709-716. [PMID: 37580278 DOI: 10.3760/cma.j.cn112152-20221006-00678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
Objective: To provide survival evidence of anthracycline-free neoadjuvant chemotherapy for patients with stages Ⅱ-Ⅲ human epidermal growth factor receptor-2 (HER-2) positive and hormone receptor (HR) negative breast cancer. Methods: The prospective cohort study was conducted at the Department of Medical Oncology of Cancer Hospital, Chinese Academy of Medical Sciences. Patients with HER-2 positive and HR negative breast cancer in stages Ⅱ-Ⅲ were enrolled to receive neoadjuvant therapy (NAT) of dose-dense paclitaxel (175 mg/m(2)) plus carboplatin (AUC=4.0) biweekly for 6 cycles in combination with trastuzumab (PCbH), and matched patients who received standard adjuvant therapy of physicians' choice were recruited for survival and safety comparison. Results: From July 2013 to November 2019, 166 patients were included (neoadjuvant 51, adjuvant 115). Compared with those who received adjuvant therapy, patients receiving NAT were younger (<35 years: 19.6% vs 5.2%, P=0.014), had larger tumors (T3: 62.7% vs 7.8%, P<0.001) and more advanced diseases (stage ⅡA: 2.0% vs 41.7%, P<0.001). Patients in the neoadjuvant group all received surgery, and 96 (83.5%) in the adjuvant group received anthracycline-and-taxane-containing regimens. A total of 98 patients (49 pairs) were matched, and the covariates between the two groups were acceptably balanced. Within a median follow-up of 46.5 (range, 14-87) months, the 4-year recurrence-free survival (RFS) rate among patients who received NAT was 73.3% (95% CI: 59.0%-87.6%), versus 80.6% (95% CI: 67.9%-93.3%) among those in the adjuvant group without statistical difference (P=0.418). A similar result was observed for the 4-year overall survival (OS) [neoadjuvant versus adjuvant: 91.5% (95% CI: 81.7%-100.0%) vs 97.8% (95% CI: 93.5%-100.0%), P=0.314]. Compared with standard adjuvant therapy, PCbH was related to less neutropenia and better cardiac safety. Conclusions: These results support the consideration of anthracycline-free neoadjuvant chemotherapy combined with anti-HER-2 therapy for patients with stages Ⅱ-Ⅲ HER-2-positive and HR-negative breast cancer. Optimized regimens with both efficacy and safety are needed and to be further investigated.
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Affiliation(s)
- M Xiu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Y Lu
- Department of Medical Oncology, the First People's Hospital of Nanning, Nanning 530016, China
| | - X Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Y Fan
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Q Li
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Q Li
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - J Y Wang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Y Luo
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - R G Cai
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - S S Chen
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - P Yuan
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - F Ma
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - B H Xu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - P Zhang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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30
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Schirone L, Vecchio D, Valenti V, Forte M, Relucenti M, Angelini A, Zaglia T, Schiavon S, D'Ambrosio L, Sarto G, Stanzione R, Mangione E, Miglietta S, Di Bona A, Fedrigo M, Ghigo A, Versaci F, Petrozza V, Marchitti S, Rubattu S, Volpe M, Sadoshima J, Frati L, Frati G, Sciarretta S. MST1 mediates doxorubicin-induced cardiomyopathy by SIRT3 downregulation. Cell Mol Life Sci 2023; 80:245. [PMID: 37566283 PMCID: PMC10421787 DOI: 10.1007/s00018-023-04877-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/30/2023] [Accepted: 07/16/2023] [Indexed: 08/12/2023]
Abstract
Heart failure is a major side effect of doxorubicin (DOX) treatment in patients with cancer. However, the mechanisms underlying the development of DOX-induced heart failure need to be addressed. This study aims to test whether the serine/threonine kinase MST1, a major Hippo pathway component, contributes to the development of DOX-induced myocardial injury. C57BL/6J WT mice and mice with cardiomyocyte-specific dominant-negative MST1 (kinase-dead) overexpression received three weekly injections of DOX, reaching a final cumulative dose of 18 mg/kg. Echocardiographic, histological and biochemical analyses were performed six weeks after the first DOX administration. The effects of MST1 inhibition on DOX-induced cardiomyocyte injury were also tested in vitro. MST1 signaling was significantly activated in cardiomyocytes in response to DOX treatment in vitro and in vivo. Wild-type (WT) mice treated with DOX developed cardiac dysfunction and mitochondrial abnormalities. However, these detrimental effects were abolished in mice with cardiomyocyte-specific overexpression of dominant-negative MST1 (DN-MST1) or treated with XMU-MP-1, a specific MST1 inhibitor, indicating that MST1 inhibition attenuates DOX-induced cardiac dysfunction. DOX treatment led to a significant downregulation of cardiac levels of SIRT3, a deacetylase involved in mitochondrial protection, in WT mice, which was rescued by MST1 inhibition. Pharmacological inhibition of SIRT3 blunted the protective effects of MST1 inhibition, indicating that SIRT3 downregulation mediates the cytotoxic effects of MST1 activation in response to DOX treatment. Finally, we found a significant upregulation of MST1 and downregulation of SIRT3 levels in human myocardial tissue of cancer patients treated with DOX. In summary, MST1 contributes to DOX-induced cardiomyopathy through SIRT3 downregulation.
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Affiliation(s)
- Leonardo Schirone
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Daniele Vecchio
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Valentina Valenti
- Department of Cardiology, Santa Maria Goretti Hospital, Latina, Italy
| | | | - Michela Relucenti
- Department of Anatomical, Sapienza University of Rome, Histological, Forensic Medicine and Orthopaedic Sciences, Rome, Italy
| | - Annalisa Angelini
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova Medical School, Padua, Italy
| | - Tania Zaglia
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova Medical School, Padua, Italy
- Veneto Institute of Molecular Medicine, Padua, Italy
- Department of Biomedical Sciences, University of Padova, Padua, Italy
| | - Sonia Schiavon
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Luca D'Ambrosio
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Gianmarco Sarto
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | | | | | - Selenia Miglietta
- Department of Anatomical, Sapienza University of Rome, Histological, Forensic Medicine and Orthopaedic Sciences, Rome, Italy
| | - Anna Di Bona
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova Medical School, Padua, Italy
| | - Marny Fedrigo
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova Medical School, Padua, Italy
| | - Alessandra Ghigo
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Turin, Italy
| | - Francesco Versaci
- Department of Cardiology, Santa Maria Goretti Hospital, Latina, Italy
| | - Vincenzo Petrozza
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | | | - Speranza Rubattu
- IRCCS Neuromed, Pozzilli, Italy
- Department of Clinical and Molecular Medicine, (Sapienza University of Rome, S. Andrea Hospital), Rome, Italy
| | - Massimo Volpe
- Department of Clinical and Molecular Medicine, (Sapienza University of Rome, S. Andrea Hospital), Rome, Italy
- IRCCS San Raffaele, Rome, Italy
| | - Junichi Sadoshima
- Department of Cell Biology and Molecular Medicine, Rutgers New Jersey Medical School, Cardiovascular Research Institute, Newark, NJ, USA
| | - Luigi Frati
- IRCCS Neuromed, Pozzilli, Italy
- Istituto Pasteur - Fondazione Cenci Bolognetti, Rome, Italy
| | - Giacomo Frati
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Sebastiano Sciarretta
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.
- IRCCS Neuromed, Pozzilli, Italy.
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Gupta A, Gogia A, Deo S, Sharma DN, Mathur S, Sagiraju HKR. Neoadjuvant chemotherapy with or without anthracyclines in combination with single HER2-targeted therapy in HER2-positive breast cancer. Cancer Treat Res Commun 2023; 36:100741. [PMID: 37453371 DOI: 10.1016/j.ctarc.2023.100741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/25/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Neoadjuvant chemotherapy (NACT) with human epidermal growth factor receptor 2 (HER2) blockade is the preferred approach for treating early and locally advanced HER2-positive breast cancer. There is a lack of robust data comparing pathological complete response (pCR) and survival outcomes in anthracycline-free and anthracycline-containing regimens with single HER2-targeted therapy. OBJECTIVES The present study retrospectively evaluated pCR between two groups: Single HER2-targeted therapy with and without anthracycline. METHODS A total of 215 HER2-positive female breast cancer patients were analyzed who received eitheranthracycline-containing EC-TH (epirubicin and cyclophosphamide, followed by docetaxel and trastuzumab)oranthracycline-free TCH [docetaxel, carboplatin and trastuzumab]. Univariate and multivariate analyses identified prognostic factors for survival and pCR.Kaplan Meier survival curvesdetermined disease-free survival(DFS) and overall survival (OS). RESULTS Baseline characteristics were comparable in both treatment groups. The pCR rate was 30.8% in the anthracycline-containing EC-TH group and 40.9% in the anthracycline-free TCH group; p = 0.140. Disease-free survival at 3 years (65.8% vs. 58.4%) and 5 years (49.2% vs. 55.2%) was similar between EC-TH and TCH groups, respectively (log-rank p = 0.550). Three-year (95.5% vs. 92.5%) and five-year (84.4% vs. 80.8%) OSwere also comparable between both groups (log-rank p = 0.485). The anthracycline-containing EC-TH group had a higher incidence of febrile neutropenia (6.4%. vs. 3.6%) and cardiac adverse events (7.7% vs. 4.4%) than the anthracycline-free TCH group. CONCLUSION Neoadjuvant anthracycline-free chemotherapy has similar pCR and survival outcomeswith favourable cardiac and non-cardiac adverse effect profiles compared with anthracycline-containing chemotherapy.
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Affiliation(s)
- Anshul Gupta
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ajay Gogia
- All India Institute of Medical Sciences (AIIMS), New Delhi, India.
| | - Svs Deo
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - D N Sharma
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sandip Mathur
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Breviglieri CNM, de Almeida MTA, Neto GZ, Teixeira RAP, Odone-Filho V, Cristofani LM. Acute promyelocytic leukemia in childhood and adolescence: treatment results of a modified AIDA protocol at a Brazilian center. Hematol Transfus Cell Ther 2023; 45 Suppl 2:S126-S130. [PMID: 36804019 PMCID: PMC10433314 DOI: 10.1016/j.htct.2022.09.1276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 08/07/2022] [Accepted: 09/11/2022] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Acute promyelocytic leukemia currently presents an excellent chance of cure with protocols based on all-trans-retinoic acid (ATRA) and anthracycline or only differentiation agents. However, high early mortality rates continue to be reported METHODS: Between 2000 and 2018, patients were enrolled and retrospectively analyzed by medical records. A modified AIDA protocol, with a 1-year shortening of the treatment duration, reduction in the number of drugs and a strategy to reduce early mortality by the postponement of the initiation of anthracyclines were employed. Overall and event-free survival rates and toxicity were analyzed RESULTS: Thirty-two patients were enrolled, of whom 56% were female, with a median age of 12 years and 34% belonged to the high-risk group. Two patients had the hypogranular variant and three had another cytogenetic alteration, in addition to the t(15;17). The median start of the first anthracycline dose was 7 days. There were two early deaths (6%) due to central nervous system (CNS) bleeding. All patients achieved molecular remission after the consolidation phase. Two children relapsed and were rescued by arsenic trioxide and hematopoietic stem cell transplantation. The presence of disseminated intravascular coagulation (DIC) at diagnosis (p = 0.03) was the only factor with survival impact. The five-year event-free survival (EFS) was 84% and 5-year overall survival (OS) was 90% CONCLUSION: The survival results were comparable to those found in the AIDA protocol, with a low rate of early mortality in relation to the Brazilian reality.
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Affiliation(s)
- Carla Nolasco Monteiro Breviglieri
- Instituto da Criança do Instituto do Tratamento do Câncer Infantil, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (ICr ITACI FMUSP), São Paulo, SP, Brazil.
| | - Maria Tereza Assis de Almeida
- Instituto da Criança do Instituto do Tratamento do Câncer Infantil, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (ICr ITACI FMUSP), São Paulo, SP, Brazil
| | - Gabriele Zampelini Neto
- Instituto da Criança do Instituto do Tratamento do Câncer Infantil, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (ICr ITACI FMUSP), São Paulo, SP, Brazil
| | - Roberto Augusto Plaza Teixeira
- Instituto da Criança do Instituto do Tratamento do Câncer Infantil, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (ICr ITACI FMUSP), São Paulo, SP, Brazil
| | - Vicente Odone-Filho
- Instituto da Criança do Instituto do Tratamento do Câncer Infantil, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (ICr ITACI FMUSP), São Paulo, SP, Brazil
| | - Lilian Maria Cristofani
- Instituto da Criança do Instituto do Tratamento do Câncer Infantil, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (ICr ITACI FMUSP), São Paulo, SP, Brazil
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Li J, Lee ARYB, Tariq A, Lau G, Yau CE, Tan LL, Tyebally SM, Lee MX, Koo CY, Sia CH. Comparing Renin-Angiotensin-Aldosterone Blockade Regimens for Long-Term Chemotherapy-Related Cardiac Dysfunction: A Network Meta-Analysis. Cardiovasc Drugs Ther 2023:10.1007/s10557-023-07457-w. [PMID: 37314568 DOI: 10.1007/s10557-023-07457-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 06/15/2023]
Abstract
PURPOSE Cancer therapies including trastuzumab and anthracyclines are cardiotoxic and cause cardiac dysfunction. To prevent cardiotoxicity, pharmacological agents used in heart failure have been administered concomitantly with cardiotoxic cancer therapy, but few studies to date have performed a head-to-head comparison of these different agents. This systematic review and network meta-analysis of randomized-controlled trials aims to evaluate the efficacy of renin-angiotensin-aldosterone system (RAAS) blockers, namely angiotensin-converting enzyme inhibitors (ACE-Is), aldosterone receptor blockers (ARBs), and mineralocorticoid receptor antagonists (MRAs), in primary prevention against chemotherapy-related cardiac dysfunction in patients receiving anthracyclines and/or trastuzumab. METHODS A systematic search was performed in major web databases for studies from inception to 15 September 2022. A Bayesian network meta-analysis model was used to assess the relative effects of competing treatments on the primary outcomes of risk of significant decline in left ventricular ejection fraction (LVEF) and mean LVEF decline. Secondary outcomes included left ventricular diastolic function, global longitudinal strain, and cardiac biomarkers. This study is registered with PROSPERO, CRD42022357980. RESULTS AND CONCLUSION Nineteen studies reported the effects of 13 interventions (N = 1905 patients). Only enalapril (RR 0.05, 95% CI 0.00-0.20) was associated with reduced risk of patients developing significant decline in LVEF relative to placebo. Subgroup analysis showed that the beneficial effect of enalapril was driven by protection against anthracycline-associated toxicity. In addition, no RAAS-inhibiting agents showed efficacy in protection against treatment with both anthracycline and trastuzumab. The use of RAAS inhibition therapy did not conclusively impact on other markers of cardiac function, including left ventricular diastolic function and cardiac biomarkers.
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Affiliation(s)
- Jiaqi Li
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | - Areeba Tariq
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Grace Lau
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chun En Yau
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Li Ling Tan
- Department of Cardiology, National University Heart Center Singapore, Singapore, Singapore
| | - Sara Moiz Tyebally
- Department of Cardiology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Matilda Xinwei Lee
- Department of Hematology-Oncology, National University Cancer Institute Singapore, Singapore, Singapore
| | - Chieh Yang Koo
- Department of Cardiology, National University Heart Center Singapore, Singapore, Singapore
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Center Singapore, Singapore, Singapore.
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Faggiano A, Gherbesi E, Cardinale D, Vicenzi M, Carugo S. SGLT2-i prevent left ventricular dysfunction induced by anthracycline in mouse model: A systematic-review and meta-analysis. Vascul Pharmacol 2023; 150:107171. [PMID: 37061151 DOI: 10.1016/j.vph.2023.107171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 04/17/2023]
Abstract
CLINICAL QUESTION Could SGLT2-i be helpful for the prevention of left ventricular dysfunction induced by anthracycline? WHAT IS THE MAIN FINDING?: SGLT2-i appear effective for the prevention of left ventricular dysfunction induced by anthracycline in mouse model.
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Affiliation(s)
- Andrea Faggiano
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy.
| | - Elisa Gherbesi
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Daniela Cardinale
- Cardioncology Unit, European Institute of Oncology, IRCCS, Milan, Italy
| | - Marco Vicenzi
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Stefano Carugo
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
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35
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Masood IR, Rezvan PH, Lee K, Vervaet H, Kuo C, Loss K, Menteer J, Souza A, Freyer D, Su JA. Left Ventricle Size Correlates with Peak Exercise Capacity in Pediatric Cancer Survivors Exposed to Anthracycline Chemotherapy. Pediatr Cardiol 2023:10.1007/s00246-023-03192-z. [PMID: 37217803 PMCID: PMC10202348 DOI: 10.1007/s00246-023-03192-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/15/2023] [Indexed: 05/24/2023]
Abstract
Cancer survivors exposed to anthracycline chemotherapy are at risk for developing cardiomyopathy, which may have delayed clinical manifestation. In a retrospective cross-sectional study, we evaluated the utility of cardiopulmonary exercise testing (CPET) for detecting early cardiac disease in 35 pediatric cancer survivors by examining the associations between peak exercise capacity (measured via percent predicted peak VO2) and resting left ventricular (LV) function on echocardiography and cardiac magnetic resonance imaging (cMRI). We additionally assessed the relationships between LV size on resting echocardiography or cMRI and percent predicted peak VO2 since LV growth arrest can occur in anthracycline-exposed patients prior to changes in LV systolic function. We found reduced exercise capacity in this cohort, with low percent predicted peak VO2 (62%, IQR: 53-75%). While most patients in our pediatric cohort had normal LV systolic function, we observed associations between percent predicted peak VO2 and echocardiographic and cMRI measures of LV size. These findings indicate that CPET may be more sensitive in manifesting early anthracycline-induced cardiomyopathy than echocardiography in pediatric cancer survivors. Our study also highlights the importance of assessing LV size in addition to function in pediatric cancer survivors exposed to anthracyclines.
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Affiliation(s)
- Imran Ross Masood
- Heart Institute, Children’s Hospital of Los Angeles, Los Angeles, USA
| | - Panteha Hayati Rezvan
- Biostatistics and Data Analysis Core, The Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, USA
| | - Kyuwan Lee
- Department of Population Sciences, City of Hope National Medical Center, Duarte, CA USA
| | - Helena Vervaet
- Present Address: Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Christopher Kuo
- Cancer and Blood Disease Institute, Children’s Hospital Los Angeles, Los Angeles, USA
| | - Karla Loss
- Heart Institute, Children’s Hospital of Los Angeles, Los Angeles, USA
| | - JonDavid Menteer
- Heart Institute, Children’s Hospital of Los Angeles, Los Angeles, USA
| | - Andrew Souza
- Heart Institute, Children’s Hospital of Los Angeles, Los Angeles, USA
| | - David Freyer
- Present Address: Keck School of Medicine, University of Southern California, Los Angeles, USA
- Cancer and Blood Disease Institute, Children’s Hospital Los Angeles, Los Angeles, USA
| | - Jennifer A. Su
- Heart Institute, Children’s Hospital of Los Angeles, Los Angeles, USA
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36
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Swedan HK, Kassab AE, Gedawy EM, Elmeligie SE. Topoisomerase II inhibitors design: Early studies and new perspectives. Bioorg Chem 2023; 136:106548. [PMID: 37094479 DOI: 10.1016/j.bioorg.2023.106548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/05/2023] [Accepted: 04/13/2023] [Indexed: 04/26/2023]
Abstract
The DNA topoisomerase enzymes are widely distributed throughout all spheres of life and are necessary for cell function. Numerous antibacterial and cancer chemotherapeutic drugs target the various topoisomerase enzymes because of their roles in maintaining DNA topology during DNA replication and transcription. Agents derived from natural products, like anthracyclines, epipodophyllotoxins and quinolones, have been widely used to treat a variety of cancers. A very active field of fundamental and clinical research is the selective targeting of topoisomerase II enzymes for cancer treatment. This thematic review summarizes the recent advances in the anticancer activity of the most potent topoisomerase II inhibitors (anthracyclines, epipodophyllotoxins and fluoroquinolones) their modes of action, and structure-activity relationships (SARs) organized chronologically in the last ten years from 2013 to 2023. The review also highlights the mechanism of action and SARs of promising new topoisomerase II inhibitors.
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Affiliation(s)
- Hadeer K Swedan
- Central Administration of Research and Health Development, Ministry of Health, and Population (MoHP), Cairo P.O. Box 11516, Egypt
| | - Asmaa E Kassab
- Department of Pharmaceutical Organic Chemistry, Faculty of Pharmacy, Cairo University, Kasr El-Aini Street, Cairo P.O. Box 11562, Egypt.
| | - Ehab M Gedawy
- Department of Pharmaceutical Organic Chemistry, Faculty of Pharmacy, Cairo University, Kasr El-Aini Street, Cairo P.O. Box 11562, Egypt; Department of Pharmaceutical Chemistry, Faculty of Pharmacy and Pharmaceutical Industries, Badr University in Cairo (BUC), Badr City, Cairo P.O. Box 11829, Egypt
| | - Salwa E Elmeligie
- Department of Pharmaceutical Organic Chemistry, Faculty of Pharmacy, Cairo University, Kasr El-Aini Street, Cairo P.O. Box 11562, Egypt
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Villacampa G, Matikas A, Oliveira M, Prat A, Pascual T, Papakonstantinou A. Landscape of neoadjuvant therapy in HER2-positive breast cancer: a systematic review and network meta-analysis. Eur J Cancer 2023:S0959-8049(23)00188-0. [PMID: 37142539 DOI: 10.1016/j.ejca.2023.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/16/2023] [Accepted: 03/21/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND The recommended preoperative approach for HER2-positive breast cancer is unclear. We aimed to investigate the following: i) what is the optimal neoadjuvant regimen and ii) whether anthracyclines could be excluded. METHODS A systematic literature search in Medline, Embase and Web of Science databases was performed. Studies had to satisfy the following criteria: i) randomised controlled trials (RCTs), ii) enroled patients treated preoperatively for HER2-positive BC (breast cancer), iii) at least one treatment group received an anti-HER2 agent, iv) available information of any efficacy end-point and v) published in English. A network meta-analysis with a frequentist framework using random-effects model was used to pool direct and indirect evidence. Pathologic complete response (pCR), event-free survival (EFS) and overall survival (OS) were the efficacy end-points of interest, and selected safety end-points were also analysed. RESULTS A total of 11,049 patients with HER2-positive BC (46 RCTs) were included in the network meta-analysis, and 32 different regimens were evaluated. Dual anti-HER2-therapy, with pertuzumab or tyrosine kinase inhibitors, combined with chemotherapy was significantly superior to trastuzumab and chemotherapy in terms of pCR, EFS and OS. However, a higher risk of cardiotoxicity was observed with dual anti-HER2-therapy. Anthracycline-based chemotherapy was not associated with better efficacy outcomes in comparison with non-anthracycline-based chemotherapy. In anthracycline-free regimens, the addition of carboplatin presented numerically better efficacy outcomes. CONCLUSION Dual HER2 blockade with chemotherapy is the recommended choice as neoadjuvant therapy for HER2-positive breast cancer, preferably by omitting anthracyclines in favour of carboplatin.
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Affiliation(s)
- Guillermo Villacampa
- SOLTI Breast Cancer Research Group, Spain; The Institute of Cancer Research, London, United Kingdom; Oncology Data Science, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Alexios Matikas
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Breast Cancer, Endocrine Tumours and Sarcoma, Karolinska University Hospital, Stockholm, Sweden
| | - Mafalda Oliveira
- SOLTI Breast Cancer Research Group, Spain; Breast Cancer Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Medical Oncology Department, Vall d'Hebron Hospital, Barcelona, Spain
| | - Aleix Prat
- SOLTI Breast Cancer Research Group, Spain; Translational Genomics and Targeted Therapies in Solid Tumours, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Department of Medical Oncology, Hospital Clinic of Barcelona, Spain; Department of Medicine, University of Barcelona, Barcelona, Spain; Reveal Genomics, Barcelona, Spain
| | - Tomás Pascual
- SOLTI Breast Cancer Research Group, Spain; Translational Genomics and Targeted Therapies in Solid Tumours, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Department of Medical Oncology, Hospital Clinic of Barcelona, Spain
| | - Andri Papakonstantinou
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Breast Cancer, Endocrine Tumours and Sarcoma, Karolinska University Hospital, Stockholm, Sweden; Breast Cancer Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain.
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Becker MMC, Arruda GFA, Berenguer DRF, Buril RO, Cardinale D, Brandão SCS. Anthracycline cardiotoxicity: current methods of diagnosis and possible role of 18F-FDG PET/CT as a new biomarker. Cardiooncology 2023; 9:17. [PMID: 36973762 PMCID: PMC10041777 DOI: 10.1186/s40959-023-00161-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 02/01/2023] [Indexed: 03/29/2023]
Abstract
Despite advances in chemotherapy, the drugs used in cancer treatment remain rather harmful to the cardiovascular system, causing structural and functional cardiotoxic changes. Positron-emission tomography associated with computed tomography (PET/CT) has emerged like a promising technique in the early diagnosis of these adverse drug effects as the myocardial tissue uptake of fluorodeoxyglucose labeled with fluorine-18 (18F-FDG), a glucose analog, is increased after their use. Among these drugs, anthracyclines are the most frequently associated with cardiotoxicity because they promote heart damage through DNA breaks, and induction of an oxidative, proinflammatory, and toxic environment. This review aimed to present the scientific evidence available so far regarding the use of 18F-FDG PET/CT as an early biomarker of anthracycline-related cardiotoxicity. Thus, it discusses the physiological basis for its uptake, hypotheses to justify its increase in the myocardium affected by anthracyclines, importance of 18F-FDG PET/CT findings for cardio-oncology, and primary challenges of incorporating this technique in standard clinical oncology practice.
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Affiliation(s)
- Mônica M C Becker
- Postgraduate Program in Surgery, Federal University of Pernambuco, Recife, State of Pernambuco, Brazil
| | - Gustavo F A Arruda
- Recife Medical School, Federal University of Pernambuco, Recife, State of Pernambuco, Brazil
| | - Diego R F Berenguer
- Postgraduate Program in Translational Health, Federal University of Pernambuco, Recife, State of Pernambuco, Brazil
| | - Roberto O Buril
- Postgraduate Program in Surgery, Federal University of Pernambuco, Recife, State of Pernambuco, Brazil
| | - Daniela Cardinale
- Cardioncology Unit, European Institute of Oncology, I.R.C.C.S., Milan, Italy
| | - Simone C S Brandão
- Postgraduate Program in Surgery, Federal University of Pernambuco, Recife, State of Pernambuco, Brazil.
- Recife Medical School, Federal University of Pernambuco, Recife, State of Pernambuco, Brazil.
- Nuclear Medicine Department, Hospital das Clínicas, Federal University of Pernambuco, 1st floor, 1235 Avenida Professor Moraes Rego, Recife, State of Pernambuco, 50670-901, Brazil.
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Veryutin DA, Doroshenko IA, Martynova EA, Sapozhnikova KA, Svirshchevskaya EV, Shibaeva AV, Markova AA, Chistov AA, Borisova NE, Shuvalov MV, Korshun VA, Alferova VA, Podrugina TA. Probing tricarbocyanine dyes for targeted delivery of anthracyclines. Biochimie 2023; 206:12-23. [PMID: 36179940 DOI: 10.1016/j.biochi.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 11/02/2022]
Abstract
Along with bright fluorescence in the near-IR range, heptamethine carbocyanine dyes possess affinity to cancer cells. Thus, these dyes could be utilized as fluorescent labels and vectors for drug delivery as covalent conjugates with cytotoxic compounds. To test the properties, structure-activity relationship, and scope of such conjugates, we synthesized drug-dye dyads of tricarbocyanine dyes with anthracycline drug daunorubicin. We used hydrophilic zwitterionic and hydrophobic positively charged benzoindoline-benzothiazole-based heptamethine dyes as terminal alkyne derivatives and N-acylated or oxime-linked daunorubicin as azido-derivatives. These two alkynes and two azides were coupled to each other by Cu-catalyzed Huisgen-Meldal-Sharpless cycloaddition (click reaction) to afford four conjugates. Molecules based on hydrophobic dyes possess submicromolar cytotoxicity to HCT116 cells. Cytotoxicity, cell penetration, intracellular distribution, apoptosis induction and the effect of antioxidants on toxicity were evaluated. The results show that the structure of the cyanine-anthracycline conjugate (hydrophilicity/hydrophobicity, charge, linker, attachment site) is important for its biological activity, thus, expansion of the chemical space of such conjugates could provide new molecular research tools for diagnostics and therapy.
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Affiliation(s)
- Dmitry A Veryutin
- Lomonosov Moscow State University, Department of Chemistry, Moscow, Russia; Gause Institute of New Antibiotics, Moscow, Russia; Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Moscow, Russia
| | - Irina A Doroshenko
- Lomonosov Moscow State University, Department of Chemistry, Moscow, Russia
| | | | | | | | | | - Alina A Markova
- Emanuel Institute of Biochemical Physics, Moscow, Russia; Nesmeyanov Institute of Organoelement Compounds, Moscow, Russia
| | - Alexey A Chistov
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Moscow, Russia; Orekhovich Research Institute of Biomedical Chemistry, Moscow, Russia
| | - Natalya E Borisova
- Lomonosov Moscow State University, Department of Chemistry, Moscow, Russia
| | - Maxim V Shuvalov
- Lomonosov Moscow State University, Department of Chemistry, Moscow, Russia; Gause Institute of New Antibiotics, Moscow, Russia
| | - Vladimir A Korshun
- Gause Institute of New Antibiotics, Moscow, Russia; Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Moscow, Russia
| | - Vera A Alferova
- Gause Institute of New Antibiotics, Moscow, Russia; Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Moscow, Russia.
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Roy S, Lakritz S, Schreiber AR, Molina E, Kabos P, Wood M, Elias A, Kondapalli L, Bradley CJ, Diamond JR. Clinical outcomes of adjuvant taxane plus anthracycline versus taxane-based chemotherapy regimens in older adults with node-positive, triple-negative breast cancer: A SEER-Medicare study. Eur J Cancer 2023; 185:69-82. [PMID: 36965330 DOI: 10.1016/j.ejca.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND Triple-negative breast cancer (TNBC) is a subtype of breast cancer associated with an aggressive clinical course. Adjuvant chemotherapy reduces the risk of recurrence and improves survival in patients with node-positive TNBC. The benefit of anthracycline plus taxane (ATAX) regimens compared with non-anthracycline-containing, taxane-based regimens (TAX) in older women with node-positive TNBC is not well characterised. METHODS Using the Surveillance, Epidemiology, and End Results-Medicare database, we identified 1106 women with node-positive TNBC diagnosed at age 66 years and older between 2010 and 2015. We compared patient clinical characteristics according to adjuvant chemotherapy regimen (chemotherapy versus no chemotherapy and ATAX versus TAX). Logistic regression was performed to estimate the odds ratios (OR) and 95% confidence intervals (CIs). Kaplan-Meier survival curves were generated to estimate 3-year overall survival (OS) and cancer-specific survival (CSS). Cox proportional hazard models were used to analyse OS and CSS while controlling for patient and tumour characteristics. RESULTS Of the 1106 patients in our cohort, 767 (69.3%) received adjuvant chemotherapy with ATAX (364/767, 47.5%), TAX (297/767, 39%) or other regimens (106/767, 13.8%). Independent predictors of which patients were more likely to receive ATAX versus TAX included more extensive nodal involvement (≥4), age, marital/partner status and non-cardiac comorbidities. There was a statistically significant improvement in 3-year CSS (81.8% versus 71.4%) and OS (70.7% versus 51.3%) with the use of any chemotherapy in our cohort (P < 0.01). Three-year CSS and OS for patients who received ATAX versus TAX were similar at 82.8% versus 83.7% (P = 0.80) and 74.2% versus 72.7% (P = 0.79), respectively. There was a trend towards improved CSS and OS in patients with four or more positive lymph nodes who received ATAX versus TAX (hazard ratio 0.66, 95% CI: 0.36-1.23, P = 0.19 and hazard ratio 0.68, 95% CI: 0.41-1.14, P = 0.14, respectively). CONCLUSION Among older women with node-positive TNBC, a majority of patients received adjuvant chemotherapy, which was associated with an improvement in CSS and OS. When compared with TAX chemotherapy, there was a trend towards better outcomes with ATAX for patients with ≥4 nodes.
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Affiliation(s)
- Savannah Roy
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Stephanie Lakritz
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Anna R Schreiber
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Elizabeth Molina
- Population Health Shared Resource, University of Colorado Cancer Center, Aurora, CO, USA
| | - Peter Kabos
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Marie Wood
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Anthony Elias
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lavanya Kondapalli
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Cathy J Bradley
- Department of Health Systems, Management, and Policy, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jennifer R Diamond
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Keshavarzian E, Sadighpour T, Mortazavizadeh SM, Soltani M, Motevalipoor AF, Khamas SS, Moazen M, Kogani M, Amin Hashemipour SM, Hosseinpour H, Valizadeh R. Prophylactic Agents for Preventing Cardiotoxicity Induced Following Anticancer Agents: A Systematic Review and Meta-Analysis of Clinical Trials. Rev Recent Clin Trials 2023; 18:112-122. [PMID: 36803186 DOI: 10.2174/1574887118666230118102252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 10/21/2022] [Accepted: 11/15/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Anthracyclines can improve survival in many types of malignancies, but dose-dependent and irreversible results following the use of anthracyclines have been associated with cardiomyopathy. This meta-analysis aimed to compare the effects of prophylactic agents for preventing cardiotoxicity induced following anticancer agents. METHODS In this meta-analysis, Scopus, Web of Science, and PubMed were surfed for articles published by December 30th, 2020. The keywords were angiotensin-converting enzyme inhibitor (ACEI), enalapril, captopril, angiotensin receptor blocker, beta blocker, metoprolol, bisoprolol, isoprolol, statin, valsartan, losartan, eplerenone, idarubicin, nebivolol, dihydromyricetin, ampelopsin, spironolactone, dexrazoxane, antioxidants, cardiotoxicity, n-acetyl-tryptamine, cancer, neoplasms, chemotherapy, anthracyclines, doxorubicin, daunorubicin, epirubicin, idarubicin, ejection fraction or a combination of them in the titles or abstracts. RESULTS A total of 17 articles out of 728 studies examining 2,674 patients were included in this systematic review and meta-analysis. Ejection fraction (EF) values in the baseline, 6-month, and 12-month follow-up in the intervention group turned out to be 62.52 ± 2.48, 59.63 ± 4.85, and 59.42 ± 4.53, whereas in the control group appeared to be 62.81 ± 2.58, 57.69 ± 4.32, and 58.60 ± 4.58, respectively. Through comparison of the two groups, EF was found to increase in the intervention group by 0.40 after 6 months (Standardized mean difference (SMD): 0.40, 95% confidence interval (CI): 0.27, 0.54), thus proving higher than that of the control groups following the cardiac drugs. CONCLUSION This meta-analysis showed that prophylactic treatment with cardio-protective drugs, including dexrazoxane, beta blocker, and ACEI drugs in patients undergoing chemotherapy with anthracycline, have a protective effect on LVEF and prevent EF drop.
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Affiliation(s)
- Ehsan Keshavarzian
- Health Care Center of Karun, Ahwaz Jondishapur University of Medical Science, Ahwaz, Iran
| | - Tella Sadighpour
- Herbert Wertheim College of Medicine, Florida International University, Florida, FL, USA.,American University of Antigua College of Medicine, Osbourn, Antigua & Barbuda
| | | | - Mohammadhossein Soltani
- Cardiologist, Fellowship of Heart Failure, Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | | | - Mohammad Moazen
- Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohamad Kogani
- Research Center for Environmental Contaminants (RCEC), Abadan University of Medical Sciences, Abadan, Iran
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Heemelaar JC, Heemelaar S, Hertel SN, Jukema JW, Sueters M, Louwerens M, Antoni ML. Cardiac and obstetric outcomes of pregnancies for women after cardiotoxic therapy in childhood: a single center observational study. BMC Cancer 2023; 23:115. [PMID: 36732710 PMCID: PMC9893596 DOI: 10.1186/s12885-023-10578-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/11/2023] [Accepted: 01/24/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Childhood cancer survivors (CCS) are at increased risk of cardiomyopathy during pregnancy if they have prior cardiotoxic exposure. Currently, there is no consensus on the necessity, timing and modality of cardiac monitoring during and after pregnancy. Therefore, we examined cardiac function using contemporary echocardiographic parameters during pregnancy in CCS with cardiotoxic treatment exposure, and we observed obstetric outcomes in CCS, including in women without previous cardiotoxic treatment exposure. METHOD A single-center retrospective cohort study was conducted among 39 women enrolled in our institution's cancer survivorship outpatient clinic. Information on potential cardiotoxic exposure in childhood, cancer diagnosis and outcomes of all pregnancies were collected through interviews and review of health records. Echocardiographic exams before and during pregnancy were retrospectively analyzed for left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) if available. The primary outcomes were (i) left ventricular dysfunction (LVD) during pregnancy, defined as LVEF < 50% or a decline of ≥ 10% in LVEF below normal (< 54%), and (ii) symptomatic heart failure (HF). Rate of obstetric and fetal complications was compared to the general population through the national perinatal registry (PERINED). RESULTS All pregnancies (91) of 39 women were included in this study. The most common malignancy was leukemia (N = 17, 43.6%). In 22 patients, echocardiograms were retrospectively analyzed. LVEFbaseline was 55.4 ± 1.2% and pre-existing subnormal LVEF was common (7/22, 31.8/%). The minimum value of LVEF during pregnancy was 3.8% lower than baseline (p = 0.002). LVD occurred in 9/22 (40.9%) patients and HF was not observed. When GLS was normal at baseline (< -18.0%; N = 12), none of the women developed LVD. Nine of out ten women with abnormal GLS at baseline developed LVD later in pregnancy. In our cohort, the obstetric outcomes seemed comparable with the general population unless patients underwent abdominal irradiation (N = 5), where high rates of preterm birth (only 5/18 born at term) and miscarriage (6/18 pregnancies) were observed. CONCLUSION Our study suggests that women with prior cardiotoxic treatment have a low risk of LVD during pregnancy if GLS at baseline was normal. Pregnancy outcomes are similar to the healthy population except when patients underwent abdominal irradiation.
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Affiliation(s)
- Julius C. Heemelaar
- grid.10419.3d0000000089452978Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Steffie Heemelaar
- grid.10419.3d0000000089452978Department of Obstetrics and Gynaecology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Svenja N. Hertel
- grid.10419.3d0000000089452978Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - J. Wouter Jukema
- grid.10419.3d0000000089452978Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands ,grid.411737.7Netherlands Heart Institute, Moreelsepark 1, 3511 EP Utrecht, The Netherlands
| | - Marieke Sueters
- grid.10419.3d0000000089452978Department of Obstetrics and Gynaecology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Marloes Louwerens
- grid.10419.3d0000000089452978Department of Internal Medicine, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - M. Louisa Antoni
- grid.10419.3d0000000089452978Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
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Bischoff H, Bigot C, Moinard-Butot F, Pflumio C, Fischbach C, Kalish M, Kurtz JE, Pierard L, Demarchi M, Karouby D, Coliat P, Pivot X, Petit T, Cox DG, Goepp L, Bender L, Trensz P. A propensity score-weighted study comparing a two- versus four-weekly pegylated liposomal doxorubicin regimen in metastatic breast cancer. Breast Cancer Res Treat 2023; 198:23-29. [PMID: 36562910 DOI: 10.1007/s10549-022-06844-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE A 4-weekly schedule of pegylated liposomal doxorubicin (PLD) has been approved for the treatment of metastatic breast cancer (MBC). Phase II trials have suggested interest in a 2-weekly regimen. This study aimed to compare the efficacy and safety of these two schedules. METHODS Data from MBC patients treated with PLD between 2011 and 2021 were retrospectively collected. The objective was to demonstrate the noninferiority of the 2-weekly versus the 4-weekly schedule in terms of 6-month progression-free survival (PFS). The prespecified noninferiority margin was calculated as 1.20. A propensity score to receive either schedule was estimated using a gradient boosting algorithm. Survival analyses using Cox regression models weighted by the propensity score were performed to compare the schedules. RESULTS Among the 192 patients included, 96 (50%) underwent each schedule. The median number of previous systemic therapies was 4 (IQR, 3 to 6). Anthracyclines were previously given in early breast cancer in 63.9% of patients. The median follow-up was 10.0 months (IQR, 5.0 to 20.1). A comparable distribution of adverse events was observed. The median PFS was 3.2 months (95% CI, 2.9 to 3.9), and the median overall survival was 12.1 months (95% CI, 10.8 to 14.9). The weighted hazard ratio for PFS was 1.12 (90% CI, 0.82 to 1.54), including the noninferiority boundaries. CONCLUSION PLD appeared to be a well-tolerated drug in this heavily pretreated MBC population. The efficacy and safety of the 2-weekly schedule did not provide any advantage, suggesting no interest in changing the registered regimen.
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Affiliation(s)
- H Bischoff
- Medical Oncology, Institut de Cancérologie Strasbourg Europe, 67033, Strasbourg, France.
| | - C Bigot
- Medical Oncology, Institut de Cancérologie Strasbourg Europe, 67033, Strasbourg, France
| | - F Moinard-Butot
- Medical Oncology, Institut de Cancérologie Strasbourg Europe, 67033, Strasbourg, France
| | - C Pflumio
- Medical Oncology, Institut de Cancérologie Strasbourg Europe, 67033, Strasbourg, France
| | - C Fischbach
- Medical Oncology, Institut de Cancérologie Strasbourg Europe, 67033, Strasbourg, France
| | - M Kalish
- Medical Oncology, Institut de Cancérologie Strasbourg Europe, 67033, Strasbourg, France
| | - J E Kurtz
- Medical Oncology, Institut de Cancérologie Strasbourg Europe, 67033, Strasbourg, France
| | - L Pierard
- Medical Oncology, Institut de Cancérologie Strasbourg Europe, 67033, Strasbourg, France
| | - M Demarchi
- Medical Oncology, Institut de Cancérologie Strasbourg Europe, 67033, Strasbourg, France
| | - D Karouby
- Pharmacy, Institut de Cancérologie Strasbourg Europe, 67033, Strasbourg, France
| | - P Coliat
- Pharmacy, Institut de Cancérologie Strasbourg Europe, 67033, Strasbourg, France
| | - X Pivot
- Medical Oncology, Institut de Cancérologie Strasbourg Europe, 67033, Strasbourg, France
| | - T Petit
- Medical Oncology, Institut de Cancérologie Strasbourg Europe, 67033, Strasbourg, France
| | - D G Cox
- Statistics, Institut de Cancérologie Strasbourg Europe, 67033, Strasbourg, France
| | - L Goepp
- Statistics, Institut de Cancérologie Strasbourg Europe, 67033, Strasbourg, France
| | - L Bender
- Medical Oncology, Institut de Cancérologie Strasbourg Europe, 67033, Strasbourg, France
| | - P Trensz
- Medical Oncology, Institut de Cancérologie Strasbourg Europe, 67033, Strasbourg, France
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Li C, Zheng Y, Niu D, Zhu R, Yan X, Qu H, Zhang Y. Effects of Traditional Chinese Medicine Injections for Anthracyclines-induced Cardiotoxicity: An Overview of Systematic Reviews and Meta-Analyses. Integr Cancer Ther 2023; 22:15347354231164753. [PMID: 37057304 PMCID: PMC10108409 DOI: 10.1177/15347354231164753] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
INTRODUCTION Traditional Chinese medicine (TCM) injections, as a relatively safe and low-cost treatment, have been widely used in the prevention and treatment of anthracyclines-induced cardiotoxicity in China. However, the quality of the relevant systematic reviews and meta-analyses published in recent years is uneven, so that the effectiveness and safety of TCM injections in preventing and treating anthracyclines-induced cardiotoxicity remain to be discussed. A systematic overview is therefore needed to provide a more advanced evidentiary reference for clinical practice. METHODS Eight Chinese and English databases were searched by computer to screen the meta-analyses/systematic reviews on the efficacy of traditional Chinese medicine injections for the prevention and treatment of anthracyclines-induced cardiotoxicity from the database establishment to October 2022. The methodological quality and evidence quality of outcome indicators included in the study were evaluated by AMSTAR 2 tool, PRISMA statement and GRADE classification. RESULTS A total of 7 articles were included in the study. The quality evaluation of AMSTAR 2 showed that 7 studies were extremely low-level; PRISMA stated that the evaluation results showed that the reports of 7 studies were of intermediate quality; The GRADE rating indicated that most of the evidence was of low quality. CONCLUSION The methodological quality and evidence quality of meta-analysis/system evaluation concerning the prevention and treatment of anthracyclines-induced cardiotoxicity by Chinese medicine are currently low, and the effectiveness of Chinese medicine in the treatment of anthracyclines-induced cardiotoxicity needs more high-quality evidence-based evidence.
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Affiliation(s)
- Chenchen Li
- The First Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
| | - Yuling Zheng
- The First Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
- Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
| | - Dong Niu
- The First Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
| | - Ranpei Zhu
- The First Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
| | - Xiaoyu Yan
- The First Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
| | - Haoran Qu
- The First Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
| | - Yaling Zhang
- The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, Henan Province, China
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Weng T, Wang L, Zhang X, Wu Y, Zhao Y, Zhang Y, Han J, Liu M. A pH-sensitive DNA tetrahedron for targeted release of anthracyclines: Binding properties investigation and cytotoxicity evaluation. Int J Biol Macromol 2022; 223:766-778. [PMID: 36372106 DOI: 10.1016/j.ijbiomac.2022.11.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/28/2022] [Accepted: 11/03/2022] [Indexed: 11/13/2022]
Abstract
The anticancer efficacy of chemotherapeutic agents can be enhanced by the loading of DNA nanostructures, which is closely related to their interactions. This study achieved pH-responsive and targeted anthracycline delivery using i-motif and MUC1 aptamer co-modified DNA tetrahedron (MUC1-TD). The thermodynamic parameters for the binding of doxorubicin (DOX) and epirubicin (EPI) to MUC1-TD at pHs 7.4 and 5.0 were obtained. The smaller binding constant and the number of binding sites at pH 5.0 than at pH 7.4 indicated that acidic conditions favored the release of DOX and EPI loaded by MUC1-TD. The binding affinity of DOX was stronger than that of EPI at the same pH value due to their different chemical stereostructures. The intercalative binding mechanism was verified. In vitro release experiments revealed that acid pH and deoxyribonuclease I accelerated the release of DOX and EPI. The faster release rate of EPI than DOX was related to their binding affinity. In vitro cytotoxicity and cell uptake experiments revealed that the cytotoxicity of DOX and EPI loaded by MUC1-TD to MCF-7 cells was significantly higher than that to L02 cells. This work will provide theoretical guidance for the application of pH-responsive MUC1-TD nanocarriers in the field of pharmaceutics.
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Affiliation(s)
- Tianxin Weng
- Institute of Biopharmaceutical Research, Liaocheng University, Hunan Road, Liaocheng 252059, China
| | - Lu Wang
- School of Chemistry and Chemical Engineering, Liaocheng University, Hunan Road, Liaocheng 252059, China
| | - Xinpeng Zhang
- Institute of Biopharmaceutical Research, Liaocheng University, Hunan Road, Liaocheng 252059, China
| | - Yushu Wu
- Institute of Biopharmaceutical Research, Liaocheng University, Hunan Road, Liaocheng 252059, China
| | - Yanna Zhao
- Institute of Biopharmaceutical Research, Liaocheng University, Hunan Road, Liaocheng 252059, China
| | - Yongfang Zhang
- Institute of Biopharmaceutical Research, Liaocheng University, Hunan Road, Liaocheng 252059, China
| | - Jun Han
- Institute of Biopharmaceutical Research, Liaocheng University, Hunan Road, Liaocheng 252059, China; Liaocheng Hi-tech Biotechnology Co., Ltd., Liaocheng 252059, China
| | - Min Liu
- Institute of Biopharmaceutical Research, Liaocheng University, Hunan Road, Liaocheng 252059, China; School of Chemistry and Chemical Engineering, Liaocheng University, Hunan Road, Liaocheng 252059, China.
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Gerodias FR, Tan MK, De Guzman A, Bernan A, Locnen SA, Apostol-Alday A, Ybanez EJ, Magno JD, Lim A, Junia A, Mambulao R, Cosare-San Pedro J, Lucero J, Quijano Z, Apurillo J, Uson AJ, Lim JL, Inso CA, Agoncillo-Infante A, Bongcawil RY, Fernando GY, Ramos-Manalaysay AM, Arellano-Simon FA, Ilagan-Cargullo EM, Bago-Azares MJ, Baterna J, Tapispisan JA, Masadao-Rodriguez NM, Tarranza JL, Lista LS, Gumapon JK. Anthracycline-Induced Cardiotoxicity in Breast Cancer Patients: A Five-Year Retrospective Study in 10 Centers. Cardiol Res 2022; 13:380-392. [PMID: 36660064 PMCID: PMC9822673 DOI: 10.14740/cr1442] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
Background Cardiotoxicity as a result of anthracycline chemotherapy has been linked to increased morbidity and mortality in breast cancer patients. There is a need for early detection through risk factor identification. To date, no large multicenter study has been conducted to describe the incidence, risk factors and clinical and demographic profiles of breast cancer patients with anthracycline-induced cardiotoxicity (AIC) in the Philippines. Methods This was a nationwide multicenter retrospective cohort study among adult breast cancer patients who underwent anthracycline chemotherapy from 2015 to 2020 in 10 sites in the Philippines. Baseline characteristics and possible risk factors for AIC were retrieved from medical records and cancer registries. AIC was defined as a reduction of left ventricular ejection fraction (LVEF) by > 10% from baseline to a value of < 53% or the development of overt left ventricular systolic dysfunction or heart failure (HF). Odds ratios from logistic regression were computed to determine risk factors associated with AIC using STATA-15.0 software. Results Out of 341 patients included, 33 had AIC, accounting for an incidence of 9.68%. Nine patients (2.6%) had clinical HF. AIC patients had a mean age of 53.91 ± 10.84 years. Breast cancer AIC patients were significantly older and had lower body mass index (BMI) than those without AIC. AIC patients had significantly more comorbidities, especially hypertension and atrial fibrillation. Multivariate analysis showed that patients with any preexisting comorbidity are approximately 12.37 times as likely to have AIC, while those with concurrent chemotherapy are 0.07 times or 93% less likely to have AIC. Conclusion Among adult breast cancer patients undergoing anthracycline chemotherapy, we determined a high incidence of cardiotoxicity at 9.68%. Having preexisting comorbidities gave patients 12 times increased odds of developing anthracycline cardiotoxicity. The presence of concurrent non-anthracycline chemotherapy showed an inverse association with the development of AIC which we attribute largely to patient selection in a retrospective study. The significantly higher propensity for AIC development in patients with preexisting comorbidities may warrant closer monitoring and control of patient comorbidities such as hypertension among patients undergoing anthracycline chemotherapy.
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Affiliation(s)
- Ferdinand R. Gerodias
- St. Luke’s Medical Center-QC, Quezon City, Philippines,Department of Medicine, St. Luke’s Medical Center College of Medicine, William H. Quasha Memorial, Quezon City, Philippines,Corresponding Author: Ferdinand R. Gerodias, Jr., Department of Medicine, St. Luke’s Medical Center College of Medicine, William H. Quasha Memorial, Quezon City, Philippines.
| | - Maria Katrina Tan
- St. Luke’s Medical Center-QC, Quezon City, Philippines,St. Luke’s Medical Center-GC, Bonifacio Global City, Philippines
| | - Arnold De Guzman
- Angeles University Foundation Medical Center, Angeles City, Pampanga, Philippines
| | - Alisa Bernan
- Davao Doctors Hospital, Davao City, Davao del Sur, Philippines
| | - Sue Ann Locnen
- St. Luke’s Medical Center-QC, Quezon City, Philippines,St. Luke’s Medical Center-GC, Bonifacio Global City, Philippines,University of the East Ramon Magsaysay Memorial Medical Center, Inc., Quezon City, Philippines
| | | | - Erwin Janino Ybanez
- University of the East Ramon Magsaysay Memorial Medical Center, Inc., Quezon City, Philippines
| | | | - Alvin Lim
- University of Santo Tomas (UST) Hospital, Manila, Philippines
| | - Alex Junia
- Perpetual Succour Hospital, Cebu City, Cebu, Philippines
| | - Ryan Mambulao
- Dona Remedios Trinidad Romualdez Hospital, Tacloban City, Leyte, Philippines
| | | | - Jonald Lucero
- Vicente Sotto Memorial Medical Center, Cebu City, Cebu, Philippines
| | - Zaldy Quijano
- Dona Remedios Trinidad Romualdez Hospital, Tacloban City, Leyte, Philippines
| | - Josephine Apurillo
- Dona Remedios Trinidad Romualdez Hospital, Tacloban City, Leyte, Philippines
| | | | | | | | | | | | | | | | | | | | | | - Jamil Baterna
- St. Luke’s Medical Center-QC, Quezon City, Philippines
| | | | | | | | - Lorenz Sagayaga Lista
- University of the East Ramon Magsaysay Memorial Medical Center, Inc., Quezon City, Philippines
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Podyacheva E, Shmakova T, Kushnareva E, Onopchenko A, Martynov M, Andreeva D, Toropov R, Cheburkin Y, Levchuk K, Goldaeva A, Toropova Y. Modeling Doxorubicin-Induced Cardiomyopathy With Fibrotic Myocardial Damage in Wistar Rats. Cardiol Res 2022; 13:339-356. [PMID: 36660062 PMCID: PMC9822674 DOI: 10.14740/cr1416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/26/2022] [Indexed: 12/23/2022] Open
Abstract
Background Cardiovascular complications, arising after anthracycline chemotherapy, cause a significant deterioration in the life quality and expectancy of those patients who were previously successfully treated for malignant neoplasms. A number of clinical studies have demonstrated that patients with cardiotoxicity manifested during anthracyclines therapy also have extensive fibrotic changes in the cardiac muscle in the long term. Given the lack of an unambiguous understanding of the mechanisms of fibrotic changes formation under doxorubicin treatment in the myocardium, there is the obvious necessity to create a relevant experimental model of chronic doxorubicin-induced cardiomyopathy with fibrotic myocardial lesions and delayed development of diastolic dysfunction. Methods The study was divided into two stages: first stage (creation of acute doxorubicin cardiomyopathy) - 35 male Wistar rats; second stage (creation of chronic doxorubicin cardiomyopathy) - 40 male Wistar rats. The animals were split into eight groups (two control ones and six experimental ones), which determined the doxorubicin dose (first stage: 25, 20.4, 15 mg/kg; second stage: 5, 10, 15 mg/kg, intraperitoneally) and the frequency of injection. Echocardiographic, hematological, histological, and molecular methods were used to confirm the successful modeling of acute and chronic doxorubicin-induced cardiomyopathy with fibrotic lesions. Results A model of administration six times every other day with a cumulative dose of doxorubicin 20 mg/kg is suitable for evaluation of acute cardiotoxicity. The 15 mg/kg doxorubicin dose is highly cardiotoxic; what's more, it correlates with progressive deterioration of the clinical condition of the animals after 2 months. The optimal cumulative dose of doxorubicin leads to clinical manifestations confirmed by echocardiographic, histological, molecular changes associated with the development of chronic doxorubicin-induced cardiomyopathy with fibrotic lesions of the left ventricular of the cardiac muscle and ensure long-term survival of animals is 10 mg/kg doxorubicin. A dose of 5 mg/kg of the doxorubicin does not ensure the development of fibrous changes formation. Conclusion We assume that cumulative dose of 10 mg/kg with a frequency of administration of six times in 2 days can be used to study the mechanisms of anthracycline cardiomyopathy development.
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Affiliation(s)
- Ekaterina Podyacheva
- Almazov National Medical Research Centre, Ministry of Health of the Russian Federation, 197341, Saint-Petersburg, Russian Federation,Corresponding Author: Ekaterina Podyacheva, Almazov National Medical Research Centre, Ministry of Health of the Russian Federation, 197341, Saint-Petersburg, Russian Federation.
| | - Tatiana Shmakova
- Almazov National Medical Research Centre, Ministry of Health of the Russian Federation, 197341, Saint-Petersburg, Russian Federation
| | - Ekaterina Kushnareva
- Almazov National Medical Research Centre, Ministry of Health of the Russian Federation, 197341, Saint-Petersburg, Russian Federation
| | - Anatoliya Onopchenko
- Almazov National Medical Research Centre, Ministry of Health of the Russian Federation, 197341, Saint-Petersburg, Russian Federation
| | - Mikhail Martynov
- Almazov National Medical Research Centre, Ministry of Health of the Russian Federation, 197341, Saint-Petersburg, Russian Federation
| | - Daria Andreeva
- Almazov National Medical Research Centre, Ministry of Health of the Russian Federation, 197341, Saint-Petersburg, Russian Federation
| | - Roman Toropov
- Almazov National Medical Research Centre, Ministry of Health of the Russian Federation, 197341, Saint-Petersburg, Russian Federation
| | - Yuri Cheburkin
- Almazov National Medical Research Centre, Ministry of Health of the Russian Federation, 197341, Saint-Petersburg, Russian Federation
| | - Ksenia Levchuk
- Almazov National Medical Research Centre, Ministry of Health of the Russian Federation, 197341, Saint-Petersburg, Russian Federation
| | - Alexandra Goldaeva
- Almazov National Medical Research Centre, Ministry of Health of the Russian Federation, 197341, Saint-Petersburg, Russian Federation
| | - Yana Toropova
- Almazov National Medical Research Centre, Ministry of Health of the Russian Federation, 197341, Saint-Petersburg, Russian Federation
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Philip LJ, Findlay SG, Gill JH. Baseline blood pressure and development of cardiotoxicity in patients treated with anthracyclines: A systematic review. Int J Cardiol Cardiovasc Risk Prev 2022; 15:200153. [PMID: 36573186 PMCID: PMC9789356 DOI: 10.1016/j.ijcrp.2022.200153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/29/2022] [Accepted: 10/03/2022] [Indexed: 11/07/2022]
Abstract
Aims Anthracyclines, a mainstay of cancer treatment, are associated with significant life-threatening cardiotoxicity. As cancer survivorship improves, there is a growing need to identify patients most at risk and strategies to mitigate anthracycline-associated cardiotoxicity. Elevated baseline blood pressure (bBP) is a possible risk factor for cardiotoxicity. The aim of this systematic review was to summarise the literature and evaluate relationships between bBP and anthracycline-associated cardiotoxicity. Methods and results Systematic searches were conducted, limited to English language but without restrictions on study type or country of origin. All studies fulfilled the PRISMA statement and relevant studies reviewed and narratively synthesised. A total of 1330 papers were screened, with 12 included in the qualitative synthesis. Eight papers indicated elevated bBP was associated with significantly higher risk of developing cardiotoxicity. Four papers noted significant relationships between left ventricular ejection fraction (LVEF) decline and elevated bBP. Of the four papers that failed to show an association, one noted increased risk of developing chronic heart failure. A relationship between baseline diastolic and systolic BP and anthracycline-associated cardiotoxicity is also noted. Conclusions This study indicates adult patients with elevated bBP have increased vulnerability to anthracycline-associated cardiotoxicity, with those with pre-hypertension or raised systolic versus diastolic pressure potentially an overlooked population. Recommendations for inclusion of bBP, incorporating individual systolic versus diastolic pressures, in cardio-oncology risk prediction models to guide clinical decision-making are thus warranted.
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Affiliation(s)
- Laura J. Philip
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, UK
| | - Simon G. Findlay
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, UK,Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, UK
| | - Jason H. Gill
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, UK,Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, UK,Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, UK,Corresponding author. School of Pharmacy, Faculty of Medical Sciences, Newcastle University, King George VI Building, Newcastle upon Tyne, NE1 7RU, UK.
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Sampaio DPS, Silva JBM, do Carmo Rassi D, Freitas AF, Rassi S. Echocardiographic strategy for early detection of cardiotoxicity of doxorubicin: a prospective observational study. Cardiooncology 2022; 8:17. [PMID: 36183108 PMCID: PMC9526268 DOI: 10.1186/s40959-022-00143-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 09/14/2022] [Indexed: 11/06/2022]
Abstract
Background Cancer chemotherapy using anthracyclines is associated with cardiotoxicity (CTX), and left ventricular ejection fraction (LVEF) analysis is not sensitive to early cardiotoxic changes. Left ventricular global longitudinal strain (LV GLS) monitoring helps screen subclinical CTX; however, the intervals at which it should be performed remain unclear. We aimed to evaluate the incidence of CTX in women with breast cancer and the associated factors and compare two echocardiographic monitoring strategies using two cutoff points for LV GLS variation. Methods Patients with breast cancer prescribed doxorubicin underwent serial LVEF and LV GLS assessments using two-dimensional echocardiography every 3 weeks for 6 months. Results We included 43 women; none developed a clinical CTX. Considering a relative reduction of LV GLS > 15%, subclinical CTX was present in 12 (27.9%) and six (14%) patients at 3-week and 3-month intervals, respectively (P = 0.28). Additionally, considering a reduction of > 12%, subclinical CTX was present in 17 (39.5%) and 10 (23.3%) patients (P = 0.16), respectively. There were no significant differences in either reference value at 3-week (P = 0.19) and 3-month intervals (P = 0.41). Age ≥ 60 years (P = 0.018) and hypertension (HTN) (P = 0.022) were associated with subclinical CTX in the univariate analysis. Conclusions There was no difference in the incidence of subclinical CTX between the two cutoff points and no benefit in performing echocardiography every 3 weeks compared with quarterly monitoring. Advanced age and HTN were associated with the development of subclinical CTX.
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Affiliation(s)
- Diogo Pereira Santos Sampaio
- grid.411195.90000 0001 2192 5801Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Federal University of Goiás, Rua 235 s/n, Setor Leste Universitário, Goiânia, Goiás 74605-050 Brazil
| | - João Batista Masson Silva
- grid.411195.90000 0001 2192 5801Department of Echocardiography, Cardiovascular Division, Hospital das Clínicas of the Federal University of Goiás, Goiânia, Goiás Brazil
| | - Daniela do Carmo Rassi
- grid.411195.90000 0001 2192 5801Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Federal University of Goiás, Rua 235 s/n, Setor Leste Universitário, Goiânia, Goiás 74605-050 Brazil
| | - Aguinaldo F. Freitas
- grid.411195.90000 0001 2192 5801Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Federal University of Goiás, Rua 235 s/n, Setor Leste Universitário, Goiânia, Goiás 74605-050 Brazil
| | - Salvador Rassi
- grid.411195.90000 0001 2192 5801Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Federal University of Goiás, Rua 235 s/n, Setor Leste Universitário, Goiânia, Goiás 74605-050 Brazil
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Arrais TR, Cavalli GD, Dos Santos BT, Pereira GB, Migliavaca CB, Grossman GB, Biolo A. MIBG cardiac imaging compared to ejection fraction in evaluation of cardiotoxicity: a systematic review. J Nucl Cardiol 2022; 29:2274-2291. [PMID: 34228328 DOI: 10.1007/s12350-021-02610-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/15/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Advances in diagnosis and treatment of cancer has improved survival but resulted in increased cardiotoxic effects. The decrease in left ventricular ejection fraction (EF), one of the pillars of diagnosis of cardiotoxicity, seems to be a late process in the evolution of the disease, so 123I-metaiodobenzylguanidine (MIBG) cardiac imaging has been proposed to detect early cardiac impairment. The aim of this systematic review was to evaluate the performance of MIBG cardiac scan in this scenario. METHODS AND RESULTS A systematic search was conducted in five international databases comparing MIBG parameters with EF for evaluation of cardiotoxicity. Twelve studies were included and separated in three groups. First, studies evaluating patients with established cardiotoxicity, in which EF was reduced and MIBG parameters were abnormal. Second, studies analyzing patients during or after treatment compared to controls, with MIBG parameters significantly different between groups in most studies, even when EF remained normal. Finally, studies analyzing anthracycline (ATC) dose-related changes, with alteration in MIBG parameters occurring even when EF was preserved. CONCLUSION Although studies had high methodological variability, cardiac sympathetic innervation imaging seems to be a promising tool for assessing early cardiotoxicity. Further studies are needed to analyze its diagnostic value in this scenario.
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Affiliation(s)
- Thaís Rossato Arrais
- Nuclear Medicine Department, Hospital Moinhos de Vento, Rua Ramiro Barcelos, 910-201, Porto Alegre, RS, 90035-001, Brazil.
- Post-graduate Program in Cardiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
| | | | | | | | - Celina Borges Migliavaca
- Post-graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Gabriel Blacher Grossman
- Nuclear Medicine Department, Hospital Moinhos de Vento, Rua Ramiro Barcelos, 910-201, Porto Alegre, RS, 90035-001, Brazil
| | - Andréia Biolo
- Post-graduate Program in Cardiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Cardiology Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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