Prevention of cardiotoxicity among survivors of childhood cancer

Abstract

This article is part of a joint Themed section with the British Journal of Pharmacology on Cardiotoxicity. The rest of the Themed section will appear in a future issue of BJP and will be available at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1476-5381 The number of survivors of childhood cancers has increased exponentially over the past few decades. However, these survivors are also at substantially increased long-term risk of morbidity and mortality, especially from treatment-related cardiotoxicity. Preventing these risks is now a priority when treating children and adolescents with cancer. Dexrazoxane reduces the risk of anthracycline-induced cardiotoxicity among adults and children with cancer without reducing its antineoplastic effects or event-free survival. Thus, it should be strongly considered as a part of therapy for children and adolescents treated with anthracyclines.

Risk–Benefit of Dexrazoxane for Preventing Anthracycline-Related Cardiotoxicity: Re-Evaluating the European Labeling

“…Several strategies can reduce the cardiac sequelae of anthracyclines in adults, including using continuous infusion rather than bolus administration, liposomal doxorubicin, beta-blockers and angiotensin converting enzyme inhibitors [42][43][44][45][46][47]. Despite these strategies, dexrazoxane is the only agent proven to protect against anthracycline-related cardiotoxicity over extended periods [32,48].…”

Comparison of long‐term outcome in anthracycline‐related versus idiopathic dilated cardiomyopathy: a single centre experience

“…AICM, defined as a > 10% reduction in left ventricular ejection fraction (LVEF), to levels <50%, compared with pre‐treatment values, is associated with rates of heart failure (HF) that range from 5% to almost 26%, depending on the population and duration of follow‐up . AICM is common also in paediatric populations with haematological and solid malignancies, and often presents as dilated cardiomyopathy progressing to a restrictive phenotype …”

Pharmacokinetics of the Cardioprotective Drug Dexrazoxane and Its Active Metabolite ADR-925 with Focus on Cardiomyocytes and the Heart

“…Over the decades of its preclinical development, it has been documented that the cardioprotective effects of DEX are robust in all species tested irrespectively of the ANT derivative . Furthermore, clinical efficacy has been firmly established in numerous trials and by their meta-analyses (van Dalen et al, 2011;Vejpongsa and Yeh, 2014a;Hutchins et al, 2017).…”