Anthracycline cardioprotection

New, less cardiotoxic agents and liposomal formulations. In general, data on whether liposomal formulations of anthracyclines reduce cardiac toxicity in children are limited.[38,39]

Prolonged infusion time. Prolonged infusion time has been associated with reduced heart failure in adult patients, but not in children.[40,41]

Concurrent administration of cardioprotectants. A variety of agents have been tested as cardioprotectants (amifostine, acetylcysteine, calcium channel blockers, carvedilol, coenzyme Q10, and L-carnitine), but none were beneficial and are not considered standard of care.[42,43]

Dexrazoxane. There are more data for dexrazoxane as a cardioprotectant, but mainly in adult patients with cancer. In particular, the U.S. Food and Drug Administration approved dexrazoxane for women with metastatic breast cancer who have received 300 mg/m2 of anthracyclines and who may benefit from further anthracycline-based therapy.[42]

Dexrazoxane. There are more data for dexrazoxane as a cardioprotectant, but mainly in adult patients with cancer. In particular, the U.S. Food and Drug Administration approved dexrazoxane for women with metastatic breast cancer who have received 300 mg/m2 of anthracyclines and who may benefit from further anthracycline-based therapy.[42]

Pediatric data show that dexrazoxane may ameliorate some markers of early cardiac toxicity for up to 5 years after therapy.[44-47]

Dexrazoxane. There are more data for dexrazoxane as a cardioprotectant, but mainly in adult patients with cancer. In particular, the U.S. Food and Drug Administration approved dexrazoxane for women with metastatic breast cancer who have received 300 mg/m2 of anthracyclines and who may benefit from further anthracycline-based therapy.[42]

Dexrazoxane may be associated with an increased risk of acute toxicities in some regimens.[48]

Dexrazoxane. There are more data for dexrazoxane as a cardioprotectant, but mainly in adult patients with cancer. In particular, the U.S. Food and Drug Administration approved dexrazoxane for women with metastatic breast cancer who have received 300 mg/m2 of anthracyclines and who may benefit from further anthracycline-based therapy.[42]

A long-term study assessed outcomes of newly diagnosed children with cancer who were treated with dexrazoxane-containing regimens in randomized clinical trials (cumulative prescribed doxorubicin dose, 100–360 mg/m2; median follow-up, 18.6 years). Dexrazoxane was not associated with cancer relapse (HR, 0.84; 95% CI, 0.63–1.13), second cancers (HR, 1.19; 95% CI, 0.62–2.30), all-cause mortality (HR, 1.07; 95% CI, 0.78–1.47), or cardiovascular mortality (HR, 1.45; 95% CI, 0.41–5.16).[49]

Dexrazoxane. There are more data for dexrazoxane as a cardioprotectant, but mainly in adult patients with cancer. In particular, the U.S. Food and Drug Administration approved dexrazoxane for women with metastatic breast cancer who have received 300 mg/m2 of anthracyclines and who may benefit from further anthracycline-based therapy.[42]

Another study evaluated long-term cardiac outcomes of 195 children with acute lymphoblastic leukemia or Hodgkin lymphoma who received doxorubicin with or without dexrazoxane in four randomized trials and patients with osteosarcoma who all received doxorubicin with dexrazoxane in a nonrandomized trial.[50]

Dexrazoxane. There are more data for dexrazoxane as a cardioprotectant, but mainly in adult patients with cancer. In particular, the U.S. Food and Drug Administration approved dexrazoxane for women with metastatic breast cancer who have received 300 mg/m2 of anthracyclines and who may benefit from further anthracycline-based therapy.[42] › Another study evaluated long-term cardiac outcomes of 195 children with acute lymphoblastic leukemia or Hodgkin lymphoma who received doxorubicin with or without dexrazoxane in four randomized trials and patients with osteosarcoma who all received doxorubicin with dexrazoxane in a nonrandomized trial.[50]

At 18.1 years since cancer diagnosis (51% dexrazoxane exposed; cumulative doxorubicin dose, 297 mg/m2), dexrazoxane administration was associated with superior left ventricular fractional shortening (absolute difference, 1.4%; 95% CI, 0.3–2.5) and ejection fraction (absolute difference, 1.6%; 95% CI, 0.0–3.2) and lower myocardial stress per B-type natriuretic peptide (-6.7 pg/mL; 95% CI, -10.6 to -2.8).

Dexrazoxane. There are more data for dexrazoxane as a cardioprotectant, but mainly in adult patients with cancer. In particular, the U.S. Food and Drug Administration approved dexrazoxane for women with metastatic breast cancer who have received 300 mg/m2 of anthracyclines and who may benefit from further anthracycline-based therapy.[42] › Another study evaluated long-term cardiac outcomes of 195 children with acute lymphoblastic leukemia or Hodgkin lymphoma who received doxorubicin with or without dexrazoxane in four randomized trials and patients with osteosarcoma who all received doxorubicin with dexrazoxane in a nonrandomized trial.[50]

Dexrazoxane use was associated with a reduced risk of lower left ventricular function (30% fractional shortening or 50% ejection fraction; OR, 0.24; 95% CI, 0.07–0.81), which was primarily observed in those treated with cumulative doxorubicin doses of 250 mg/m2 or higher.