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.
"In 2010, the Cochrane Library reported a systematic review of the different anthracycline compounds and their cardiotoxicity . Studies by Harris and Batist were analyzed together and authors concluded that nonpegylated liposomal anthracyclines reduced the overall risk of cardiotoxicity (RR = 0.38, P < 0.0001) and the risk of clinical heart failure (RR = 0.20, P = 0.02). "
[Show abstract][Hide abstract] ABSTRACT: Drug delivery systems can provide enhanced efficacy and/or reduced toxicity for anticancer agents. Liposome drug delivery systems are able to modify the pharmacokinetics
and biodistribution of cytostatic agents, increasing the concentration of the drug released to neoplastic tissue and reducing the exposure of normal tissue. Anthracyclines are a key drug in the treatment of both metastatic and early breast cancer, but one of their major limitations is cardiotoxicity. One of the strategies designed to minimize this side effect is liposome encapsulation. Liposomal anthracyclines have achieved highly efficient drug encapsulation and they have proven to be effective and with reduced cardiotoxicity, as a single agent or in combination with other drugs for the treatment of either anthracyclines-treated or naïve metastatic breast cancer patients. Of particular interest is the use of the combination of liposomal anthracyclines and trastuzumab in patients with HER2-overexpressing breast cancer. In this paper, we discuss the different studies on liposomal doxorubicin in metastatic and early breast cancer therapy.
"Liposomal formulations of doxorubicin (and less commonly , daunomycin) have been developed based on the premise that they are less likely to extravasate from normal vasculature and be taken up by healthy tissue . Studies conducted mostly in adult cancer patients appear to show a strong protective effect associated with liposomal doxorubicin compared with the native form, with an estimated 80% reduction in clinical cardiac outcomes and a 60–70% decrease in subclinical outcomes  . Of note, there were no differences in reported tumor response. "
[Show abstract][Hide abstract] ABSTRACT: Cardiovascular complications are a leading cause of therapy-related morbidity and mortality in long-term survivors of childhood malignancy. In fact, childhood cancer survivors are at a 15-fold risk of developing CHF compared to age-matched controls. There is a strong dose-dependent association between anthracycline exposure and risk of CHF, and the incidence increases with longer followup. Outcome following diagnosis of CHF is generally poor, with overall survival less than 50% at 5 years. The growing number of childhood cancer survivors makes it imperative that strategies be developed to prevent symptomatic heart disease in this vulnerable population. We present here an overview of the current state of knowledge regarding primary, secondary, and tertiary prevention strategies for childhood cancer survivors at high risk for CHF, drawing on lessons learned from prevention studies in nononcology populations as well as from the more limited experience in cancer survivors.
Cardiology Research and Practice 08/2012; 2012(1):713294. DOI:10.1155/2012/713294
"An alternative strategy is not to treat cardiotoxicity once it has developed, but to use anthracyclines that are not cardiotoxic, which provide the same efficacy, but a reduced or no risk of long-term cardiotoxicity. The use of liposomal anthracyclines has been shown to reduce the cardiotoxicity of anthracycline treatment, compared with the conventional forms.26 "
[Show abstract][Hide abstract] ABSTRACT: A taskforce of the International Society of Geriatric Oncology (SIOG) has recently submitted recommendations on the use of anthracyclines in elderly patients. Despite the aging of the population and the high proportion of elderly individuals in the population of patients with non-Hodgkin's lymphoma, the development of specialist expertise in the treatment of elderly patients with cancer is relatively recent. Treatment of the elderly is complex because they are a highly heterogeneous population, with large variations in health status, comorbidities and life expectancy. In addition, these patients are generally more susceptible than young patients to the cardiotoxic effects of anthracyclines. Strategies for assessing elderly patients with cancer, reducing the risk of congestive heart failure, and assessing the cardiotoxic effects of treatments are discussed. In addition, a summary of the SIOG recommendations is presented.
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