A Review of Cardiotoxicity Risk Mitigation in the Use of Anthracyclines in Treating Cancer
Anthracyclines are used to treat many types of cancer and have long been recognized to treat cardiotoxic effects. With increasing cancer survivorship for both pediatric and adult cancers, those millions living with anthracycline-induced cardiotoxicity are expected to increase, contributing to billions in annual healthcare costs in the U.S. alone. There are a variety of risk-mitigation strategies, several of which are promising, that can be employed to reduce cardiotoxic effects and/or trigger early intervention to reduce progression to cardiomyopathy, heart failure, and even untimely death. The concern is that cardiotoxicity from anthracyclines may be under-recognized among primary care providers, who may not have full access to the patient’s medical histories, especially in underserved areas, and this can lead to more cases of anthracycline-induced cardiotoxicity being missed and progression on to overt heart failure prior to any intervention, at which point the odds of recovery decrease. Both pharmacologic and nonpharmacologic classes of interventions can be used as well as monitoring for cardiotoxicity. High-risk individuals include those with genetic susceptibility and those with preexisting cardiac pathology due to both modifiable and nonmodifiable risk factors, as well as those with other comorbidities such as type II diabetes mellitus or ischemic disease that predispose them to cardiomyopathy. Interventions studied included dexrazoxane, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta blockers, aerobic exercise, monitoring, genetic testing, remote ischemic conditioning, and cell therapy. A systematic review of the literature for each of these interventions was undertaken to examine the association between each of the risk mitigation interventions for anthracycline-induced cardiotoxicity and reduction of morbidity and/or mortality. Major conclusions are that there is a need for improvement in the quality of studies and the content of study reports, including standardization of definitions of cardiotoxicities and inclusion of epidemiologic measures of risk. There is supportive evidence for prophylactic use of ACE-I, ARB, and β-blockers for patients exposed to anthracyclines. Also, there is support for continuing to monitor for changes in cardiac function and intervene with ACE-I and/or ARB and/or β-blockers and/or cardiology referrals. These interventions should be tracked to identify process gaps to ensure all patients receive optimal protection.
Quintanilla, M'Lissa Louise, "A Review of Cardiotoxicity Risk Mitigation in the Use of Anthracyclines in Treating Cancer" (2017). Texas Medical Center Dissertations (via ProQuest). AAI10641940.