Dalen EC, Michiels EM, Caron HN, Kremer LC. Different anthracycline derivates for reducing cardiotoxicity in cancer patients. Cochrane Database Syst Rev 5:CD005006
ABSTRACT Anthracyclines are among the most effective chemotherapy treatments available for various types of cancer. However, there is a risk of damage to the heart depending on the cumulative dose. In an effort to prevent heart damage different anthracycline derivates (like doxorubicin, daunorubicin, and epirubicin) are being used. The authors found that for the use of many different combinations of anthracycline derivates there was no high quality evidence available and it was impossible to draw conclusions. For the use of epirubicin versus doxorubicin, there was some suggestion of a lower rate of clinical heart failure in patients treated with epirubicin. There is no evidence which suggests a difference in anti-tumour response rate and survival between epirubicin and doxorubicin. No conclusions can be made regarding adverse effects. There are no data for children and patients with leukaemia. Further research is needed. For the use of doxorubicin versus liposomal-encapsulated doxorubicin, the authors found a significantly lower rate of both clinical heart failure and subclinical heart failure (i.e. various cardiac abnormalities, diagnosed with different diagnostic methods like echocardiography in asymptomatic patients) in patients treated with liposomal-encapsulated doxorubicin. There is no evidence which suggests a difference in anti-tumour response rate and survival between doxorubicin and liposomal-encapsulated doxorubicin. A lower rate of adverse effects was identified in patients treated with liposomal-encapsulated doxorubicin. There are no data for children and patients with leukaemia. Further research is needed.
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ABSTRACT: A phase II, open, nonrandomized trial was carried out in a group of epirubicin-treated cancer patients with the aim of detecting early preclinical changes that are predictive of the risk for heart failure. Thirty-one patients (male/female ratio, 8/23; mean age +/- standard deviation, 59 +/- 14 years) with tumors at different sites and scheduled to be treated with an epirubicin-based chemotherapy regimen, were enrolled. We prospectively evaluated the acute (1 week after) and late (3, 6, 12, and 18 months of follow-up) effects of epirubicin administration. A significant impairment in systolic left ventricular (LV) function was observed at a cumulative epirubicin dose of 200 mg/m(2). This was shown by a reduction in the strain rate (SR) peak in comparison with baseline and persisted throughout the treatment and follow-up, up to 18 months; strain (Sigma) remained unchanged. The Sm wave showed a progressive reduction that became significant only at the 18-month follow-up. On TDI the E(m)/A(m) ratio declined at the 200-mg/m(2) cumulative epirubicin dose versus baseline and persisted throughout the treatment and up to the 18-month follow-up. On conventional echocardiography the E/A ratio declined significantly only at the 300-mg/m(2) cumulative epirubicin dose. Interleukin (IL)-6, soluble IL-6 receptor, and reactive oxygen species (ROS) increased significantly at the 200-mg/m(2) dose, and IL-6 was persistently high at the 300- and 400-mg/m(2) doses, returning to within baseline values during follow-up. ROS, after the peak reached at the 200-mg/m(2) dose, returned to within baseline values. A significant inverse correlation between DeltaSR and the increase in both IL-6 and ROS was observed. A multiple regression analysis showed that both the IL-6 and ROS variables were independent and strongly predictive of DeltaSR. The clinical meaningfulness of our findings warrants further investigations on a larger number of patients for a longer period of follow-up.The Oncologist 01/2009; 13(12):1296-305. DOI:10.1634/theoncologist.2008-0151 · 4.54 Impact Factor
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ABSTRACT: Anthracyclines are valuable cytotoxic agents in cancer treatment. However, their usefulness is limited by cumulative dose-dependent cardiotoxicity that may manifest as life-threatening congestive heart failure. To avoid cardiotoxicity, the use of doxorubicin is typically capped at a safe cumulative dose. Liposomal formulations may reduce cardiac risks whilst maintaining anti-cancer efficacy. Efficacy and safety studies of non-pegylated liposomal doxorubicin (NPLD) in metastatic breast cancer (MBC) are reviewed, along with studies that examine efficacy and cardiac tolerability in combination with newer agents such as paclitaxel and trastuzumab. These show that cardiac safety of liposomal doxorubicin is similar to that of epirubicin in cumulative dose, but that the formulation, unlike epirubicin, has similar anti-cancer efficacy to doxorubicin at equimolar doses. Liposomal doxorubicin may have a better therapeutic index than non-liposomal anthracyclines. This justifies further studies in patients where cumulative cardiotoxicity is a concern, as does study of its use with other potentially cardiotoxic agents.Breast (Edinburgh, Scotland) 09/2009; 18(4):218-24. DOI:10.1016/j.breast.2009.05.004 · 2.58 Impact Factor
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ABSTRACT: Aggressive fibromatosis (AF) or desmoid tumour is a monoclonal proliferation which is locally invasive but does not metastasize. If local treatment fails to control the disease, systemic treatment with anti-oestrogens, non-steroidal anti-inflammatory drugs (NSAIDs) or chemotherapy can be used. Recent reports indicate that pegylated liposomal doxorubicin (PLD) is effective. Twelve patients with AF received PLD between February 2006 and May 2009. PLD was administered intravenously (iv) at 50mg/m(2) over 1h every 4 weeks. The female/male ratio was 11:1 and median age at presentation was 29 years (range 3-53). Objective response (PR) was achieved in 4 (36%) of 11 patients. In one case ongoing shrinkage of the tumour was observed for over 12 months and partial remission was achieved at 14 months after the completion of treatment. Seven patients achieved stable disease. One patient is currently undergoing chemotherapy. Clinical benefit in terms of pain relief, improved mobility or cosmesis was observed in 11 patients. Nine patients (75%) had no evidence of progression at the end of this follow-up period and disease control has ranged from 7 to 39 months with a median of 14 months. The most severe toxicities observed were palmar-plantar erythema (4) and mucositis (3). In 6 cases (55%) toxicity resulted in dose reduction. This is the largest series of patients with AF receiving PLD reported to date. PLD as a single agent therapy has acceptable toxicity and highly promising activity in unresectable AF and may provide long-term clinical benefit in some patients.European journal of cancer (Oxford, England: 1990) 09/2009; 45(17):2930-4. DOI:10.1016/j.ejca.2009.08.016 · 4.82 Impact Factor