Early Detection of Anthracycline Cardiotoxicity and Improvement With Heart Failure Therapy

By D. Cardinale, A. Colombo, G. Bacchiani, I. Tedeschi, C. Meroni, F. Veglia, M. Civelli, Giuseppina Lamantia, N. Colombo, Giuseppe Curigliano and 2 more. Circulation, 2015

1,450 citations recorded by the source corpus.

Background— Three types of anthracycline-induced cardiotoxicities are currently recognized: acute, early-onset chronic, and late-onset chronic. However, data supporting this classification are lacking. We prospectively evaluated incidence, time of occurrence, clinical correlates, and response to heart failure therapy of cardiotoxicity. Methods and Results— We assessed left ventricular ejection fraction (LVEF), at baseline, every 3 months during chemotherapy and for the following year, every 6 months over the following 4 years, and yearly afterward in a heterogeneous cohort of 2625 patients receiving anthracycline-containing therapy. In case of cardiotoxicity (LVEF decrease >10 absolute points, and <50%), heart failure therapy was initiated. Recovery from cardiotoxicity was defined as partial (LVEF increase >5 absolute points and >50%) or full (LVEF increase to the baseline value). The median follow-up was 5.2 (quartile 1 to quartile 3, 2.6–8.0) years. The overall incidence of cardiotoxicity was 9% (n=226). The median time elapsed between the end of chemotherapy and cardiotoxicity development was 3.5 (quartile 1 to quartile 3, 3–6) months. In 98% of cases (n=221), cardiotoxicity occurred within the first year. Twenty-five (11%) patients had full recovery, and 160 (71%) patients had partial recovery. At multivariable analysis, end-chemotherapy LVEF (hazard ratio, 1.37; 95% confidence interval, 1.33–1.42 for each percent unit decrement) and cumulative doxorubicin dose (hazard ratio, 1.09; 95% confidence interval, 1.04–1.15 for each 50 mg/m2 increment) were independent correlates of cardiotoxicity. Conclusions— Most cardiotoxicity after anthracycline-containing therapy occurs within the first year and is associated with anthracycline dose and LVEF at the end of treatment. Early detection and prompt therapy of cardiotoxicity appear crucial for substantial recovery of cardiac function.

Subfields: Cardiology and Cardiovascular Medicine, Oncology, Pathology and Forensic Medicine

View Paper: https://www.semanticscholar.org/paper/0a75def40cedb5566e5e138cec1ac25943b61764

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In Cardiology and Cardiovascular Medicine

In Oncology

J. Herrmann

In Pathology and Forensic Medicine

Jeroen J. Bax

Citations in the corpus

2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: The Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC). (2016, methodology): “If rechallenge with a drug having previously generated cardiotoxicity is planned, continuation with cardioprotective drug therapy such as ACE inhibitors and beta-blockers is strongly recommended.(36,230) Other potential options include the selection of preparations with a potentially less cardiotoxi”
Prevention of cardiac dysfunction during adjuvant breast cancer therapy (PRADA): a 2 × 2 factorial, randomized, placebo-controlled, double-blind clinical trial of candesartan and metoprolol (2016, neutral): “, who in a prospective study of 2625 anthracycline-receiving patients reported an association between end-of-chemotherapy LVEF and cardiotoxicity development.(6) In our study, concomitant treatment with candesartan prevented the early LVEF decline associated with adjuvant therapy for breast cancer.”
Management of cardiac disease in cancer patients throughout oncological treatment: ESMO consensus recommendations (2020, background): “Patients with anti-VEGF-based therapy with signs and symptoms of HF.”
Anthracycline Chemotherapy and Cardiotoxicity (2017, background): “tients and documented a single linear time course for anthracycline cardiotoxicity defined as a fall in LVEF [37].”
2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines (2016, methodology): “If rechallenge with a drug having previously generated cardiotoxicity is planned, continuation with cardioprotective drug therapy such as ACE inhibitors and beta-blockers is strongly recommended.(36,230) Other potential options include the selection of preparations with a potentially less cardiotoxi”