Concomitant administration of dexrazoxane, continuous anthracycline infusion, and use of liposomal-encapsulated doxorubicin reduce the risk of anthracycline-induced cardiotoxicity.
Systematic Review
Do interventions for prevention, detection, or management reduce cancer treatment-induced cardiotoxicity in patients with cancer?
While strategies like dexrazoxane and liposomal anthracyclines can prevent cardiotoxicity, there is a significant lack of high-quality evidence to guide the detection and management of cancer treatment-induced cardiotoxicity.
BACKGROUND: The benefits associated with some cancer treatments do not come without risk. A serious side effect of some common cancer treatments is cardiotoxicity. Increased recognition of the public health implications of cancer treatment-induced cardiotoxicity has resulted in a proliferation of systematic reviews in this field to guide practice. Quality appraisal of these reviews is likely to limit the influence of biased conclusions from systematic reviews that have used poor methodology related to clinical decision-making. The aim of this meta-review is to appraise and synthesise evidence from only high quality systematic reviews focused on the prevention, detection or management of cancer treatment-induced cardiotoxicity. METHODS: Using Cochrane methodology, we searched databases, citations and hand-searched bibliographies. Two reviewers independently appraised reviews and extracted findings. A total of 18 high quality systematic reviews were subsequently analysed, 67 % (n = 12) of these comprised meta-analyses. RESULTS: One systematic review concluded that there is insufficient evidence regarding the utility of cardiac biomarkers for the detection of cardiotoxicity. The following strategies might reduce the risk of cardiotoxicity: 1) The concomitant administration of dexrazoxane with anthracylines; 2) The avoidance of anthracyclines where possible; 3) The continuous administration of anthracyclines (>6 h) rather than bolus dosing; and 4) The administration of anthracycline derivatives such as epirubicin or liposomal-encapsulated doxorubicin instead of doxorubicin. In terms of management, one review focused on medical interventions for treating anthracycline-induced cardiotoxicity during or after treatment of childhood cancer. Neither intervention (enalapril and phosphocreatine) was associated with statistically significant improvement in ejection fraction or mortality. CONCLUSION: This review highlights the lack of high level evidence to guide clinical decision-making with respect to the detection and management of cancer treatment-associated cardiotoxicity. There is more evidence with respect to the prevention of this adverse effect of cancer treatment. This evidence, however, only applies to anthracycline-based chemotherapy in a predominantly adult population. There is no high-level evidence to guide clinical decision-making regarding the prevention, detection or management of radiation-induced cardiotoxicity.
Conway et al. (Wed,) conducted a systematic review in Cancer treatment-induced cardiotoxicity. Cardioprotective strategies (dexrazoxane, continuous infusion, liposomal doxorubicin) vs. Standard anthracycline therapy was evaluated on Clinical heart failure / cardiotoxicity. Concomitant administration of dexrazoxane, continuous anthracycline infusion, and use of liposomal-encapsulated doxorubicin reduce the risk of anthracycline-induced cardiotoxicity.
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