Why the study?
Most pediatric oncology groups assume anthracycline hematologic toxicity equals cardiotoxicity, prompting the need to determine optimal dose equivalence ratios for late-onset cardiomyopathy between doxorubicin and other anthracyclines or mitoxantrone.
Do daunorubicin, epirubicin, idarubicin, or mitoxantrone alter the risk of late-onset cardiomyopathy compared to doxorubicin in childhood cancer survivors?
Population
28 423 childhood cancer survivors who survived 5 or more years
Comparison
Cumulative doses of daunorubicin, epirubicin, idarubicin, or mitoxantrone vs doxorubicin
Design
Multicenter pooled cohort study
Follow-up
Median 20.0 years (range, 5.0-40.0 years)
Authors
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Mitoxantrone may confer substantially higher late cardiomyopathy risk than doxorubicin in survivors; challenges current equivalency assumptions and leaves prospective validation open.
Do daunorubicin, epirubicin, idarubicin, or mitoxantrone alter the risk of late-onset cardiomyopathy compared to doxorubicin in childhood cancer survivors?
Mitoxantrone carries a much higher risk of late-onset cardiomyopathy (10.5-fold) than doxorubicin, challenging the current 4:1 hematologic-based equivalency assumption used in pediatric oncology.
Feijen et al. (2019) studied this question.
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