Speckle-Tracking Echocardiography to Detect Cardiac Toxicity in Children Who Received Anthracyclines During Pregnancy

Avilés, Agustín; Nambo, M. Jesús; Huerta‐Guzmán, Judith; Neri, Natividad; Cleto, Sérgio

doi:10.1016/j.clml.2015.09.009

Cited by 7 publications

(3 citation statements)

References 19 publications

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“…However, the diastolic blood pressure was higher in chemotherapy-exposed and anthracycline-exposed versus control children, but the clinical relevance may be limited. The overall normal cardiac findings are consistent with our previous findings in the 3-year-old cohort and other studies [ 6 , [20] , [21] , [22] ].…”

Section: Discussionsupporting

confidence: 92%

Child development at 6 years after maternal cancer diagnosis and treatment during pregnancy

Vandenbroucke

Verheecke

Gerwen

et al. 2020

European Journal of Cancer

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Background Data on the long-term effects of prenatal exposure to maternal cancer and its treatment on child development are scarce. Methods In a multicenter cohort study, the neurologic and cardiac outcomes of 6-year-old children born to women diagnosed with cancer during pregnancy were compared with the outcome of children born after an uncomplicated pregnancy. Assessment included clinical evaluation, comprehensive neuropsychological testing, electrocardiography and echocardiography. Results In total, 132 study children and 132 controls were included. In the study group, 97 children (73.5%) were prenatally exposed to chemotherapy (alone or in combination with other treatments), 14 (10.6%) to radiotherapy (alone or in combination), 1 (0.8%) to trastuzumab, 12 (9.1%) to surgery alone and 16 (12.1%) to no treatment. Although within normal ranges, statistically significant differences were found in mean verbal IQ and visuospatial long-term memory, with lower scores in the study versus control group (98.1, 95% confidence interval [CI]: 94.5–101.8, versus 104.4, 95% CI: 100.4–108.4, P = 0.001, Q < 0.001 [Q refers to the false discovery rate adjusted P value], and 3.9, 95% CI: 3.6–4.3, versus 4.5, 95% CI: 4.1–4.9, P = 0.005, Q = 0.045, respectively). A significant difference in diastolic blood pressure was found, with higher values in chemotherapy-exposed (61.1, 95% CI: 59.0 to 63.2) versus control children (56.0, 95% CI 54.1 to 57.8) (P < 0.001, Q < 0.001) and in a subgroup of 59 anthracycline-exposed (61.8, 95% CI: 59.3 to 64.4) versus control children (55.9, 95% CI: 53.6 to 58.1) (P < 0.001, Q = 0.02). Conclusions Children prenatally exposed to maternal cancer and its treatment are at risk for lower verbal IQ and visuospatial long-term memory scores and for higher diastolic blood pressure, but other cognitive functions and cardiac outcomes were normal at the age of 6 years. Clinical trial registration The study is registered at ClinicalTrials.gov, NCT00330447 .

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Section: Discussionsupporting

confidence: 92%

Child development at 6 years after maternal cancer diagnosis and treatment during pregnancy

Vandenbroucke

Verheecke

Gerwen

et al. 2020

European Journal of Cancer

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“…Several studies investigated the outcome of children after intrauterine exposure to potentially cardiotoxic drugs, e.g., anthracyclines. No structural defects were observed during speckle-tracking echocardiographic examination in 90 children aged 5 years or older after intrauterine exposure to anthracyclines [ 95 ] and similar reassuring results were reported by Amant et al in 69 children after intrauterine exposure to chemotherapy [ 77 ]. ECG measurements revealed no arrhythmia or conduction abnormalities [ 77 ].…”

Section: Obstetrical Management In Women With Cancer In Pregnancysupporting

confidence: 66%

Cancer and Pregnancy: A Comprehensive Review

Schwab

Anić

Hasenburg

2021

Cancers

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Cancer diagnosis and treatment in pregnant women is a challenging situation. A multidisciplinary network of specialists is required to guide both, the expecting mother and the unborn child through the diagnostic workup and the cytotoxic therapy, by balancing the respective risks and benefits. Tumor entity, stage, biology and gestational week at diagnosis determine the appropriate approach. As premature delivery emerged as one of the main risk factors for adverse long-term outcome of the progeny, it should be avoided, if reasonable from the oncological perspective. This article offers a comprehensive review with respect to the various aspects of cancer in pregnancy.

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“…An observational study used speckle-tracking echocardiography, a recently developed technique for characterizing and quantifying myocardial deformation, in children >5 years old whose mothers had received anthracyclines during pregnancy. In this case-control study this technique found the use of anthracyclines for hematological malignancies during pregnancy was not associated with differences between case and control groups in fraction shortening, interventricular septum, left ventricular posterior wall, left ventricular end-diastolic diameter, left ventricular ejection fraction, and right ventricular end-diastolic diameter [ 76 ].…”

Section: Discussionmentioning

confidence: 99%

Does anthracycline-based chemotherapy in pregnant women with cancer offer safe cardiac and neurodevelopmental outcomes for the developing fetus?

Framarino-dei-Malatesta

Sammartino

Napoli

2017

BMC Cancer

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BackgroundCancer treatment during pregnancy is a growing problem especially now that women delay childbearing. Systemic treatment of these malignancies during pregnancy centers mainly on the anticancer drugs anthracyclines, widely used in treating hematological and breast cancer during pregnancy and sometimes associated with early and late toxicity for the fetus. Owing to concern about their cardiac and neurodevelopmental toxicity more information is needed on which anthracycline to prefer and whether they can safely guarantee a cardiotoxicity-free outcome in the fetus.DiscussionThe major research findings underline anthracycline-induced dose-dependent effects, including cardiotoxicity, many avoidable. Partly because the placenta acts mainly as a barrier, research findings indicate low transplacental anthracycline transfer. Anthracycline-induced teratogenicity depends closely on when patients receive chemotherapy. Anthracycline cardiac toxicity may depend on the association with drugs that inhibit or induce placental P-glycoprotein (P-gp). P-gp-induced drug interactions may alter placental P-gp barrier function and subsequently change fetal exposure. Though many anthracyclines have acceptable safety profiles clinical studies suggest giving idarubicin with special caution. Patients and doctors who care for pregnant women should whenever possible avoid prematurity and hence reduce prematurity-induced medical complications at birth and in the long-term. Information is lacking on long-term anthracycline-induced effects.ConclusionPregnant women receiving anthracycline-based chemotherapy should undergo regular, state-of-the-art diagnostic imaging to detect fetal drug-induced cardiac damage early, and allow alternative therapeutic options. Recognizing drug-induced interactions and understanding the most vulnerable fetuses will help in choosing tailored therapy. Future research on placental transport, blood-brain barrier drug passage and pharmacokinetics will improve the way we manage these difficult-to-treat patients and their fetuses.

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Speckle-Tracking Echocardiography to Detect Cardiac Toxicity in Children Who Received Anthracyclines During Pregnancy

Cited by 7 publications

References 19 publications

Child development at 6 years after maternal cancer diagnosis and treatment during pregnancy

Child development at 6 years after maternal cancer diagnosis and treatment during pregnancy

Cancer and Pregnancy: A Comprehensive Review

Does anthracycline-based chemotherapy in pregnant women with cancer offer safe cardiac and neurodevelopmental outcomes for the developing fetus?

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