STUDY THE EFFECT OF CHEMOTHERAPY ON THE CARDIAC FUNCTION.

  • Professor of cardiology Benha university.
  • Lecturer of cardiology Benha university.
  • Lecturer of medical oncology National cancer institute Cairo university.
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Advances in cancer therapy have resulted in significant improvement in long-term survival for many types of cancer but have also resulted in untoward side effects associated with treatment. One such complication that has become increasingly recognized is the development of cardiomyopathy and heart failure. The anthracyclines are arguably one of the most active groups of chemotherapy agents in oncology. Echocardiography has been employed to measure left ventricular ejection fraction as chemotherapy progresses, and once decreases in function are identified, chemotherapy dosage or frequency is modified, or the chemotherapy is stopped. Purpose: To detect the side effects of the chemotherapeutic agents on the cardiac function and to estimate the incidence and the features of subclinical cardiotoxicity induced after conventional treatment with doxorubicin-based chemotherapy for lymphoma and breast cancer patients Patients and Methods: This observational non controlled cross sectional study conducted in order to identify the clinical and Echo-Doppler signs of cardiovascular affection induced by Anthracyclines–based chemotherapy in female patients with breast cancer and lymphoma. Echocardiograms were performed before and 6 cycles after intiation of therapy with anthracyclines,. Clinical cardiomyopathy was defined by the presence of clinical signs of congestive heart failure (CHF) and decrease of left ventricular ejection fraction (EF). Cumulative dose of doxorubicin, diabetes, dyslipidemia, older age were evaluated as potential risk factors for the development of cardiac dysfunction. Results: Cardiotoxic side effects developed in about one fourth of cancer breast patients and also lymphoma patients after Doxorubicin therapy .These toxicity were in the form of dilated cardiomyopathy (8.7%) in breast cancer patients and (8%) in lymphoma patients , pulmonary hypertension (7.3%) in breast cancer patients and (4%) in lymphoma patients, diastolic dysfunction (10%) in breast cancer patients and ( 12% ) in lymphoma ,mitral regurgitation (12%)in breast cancer patients and (8%) in lymphoma patients and abnormal ECG changes ( 13 % ). The most evident risk factors for the development of cardiotoxicity is the cumulative dose, advanced age, Diabetes Mellitus, Dyslipidemia and hypertension.anthracycline induced cardiomyopthy is related to number of received cycles of doxurubicin .A change in the left ventricular dimensions and functions ( systolic and diastolic) as determined by echocardiography, may be an indicator of developing cardiotoxicity Conclusion: chemotherapy induced cardiomyopathy is a serious complication of cancer therapy rendering the timely identification of high-risk patients the key to reducing this risk. A unified acceptable definition of chemotherapy induced cardiomyopathy adopted by cardiologists and oncologists must be developed.

  1. Ajani ja, dimery i, chawla sp et al 1986. phase ii studies of homoharringtonine in patients with advanced malignant melanoma; sarcoma; and head and neck, breast, and colorectal carcinomas.cancer treat rep. 1986;70:375–9.[pubmed]
  2. Ausmith LA, Cornelius VR, Plummer CJ, et al 2010 : Cardiotoxicity of anthracycline agents for the treatment of cancer: systematic review and meta-analysis of randomised controlled trials ASOBMC Cancer. 2010;10:337.
  3. Agennari, B Salvadori, S Donati, et al 1999 :Cardiotoxicity of epirubicin/paclitaxel–containing regimens:Role of cardiac risk factors...Journal of clinical oncology 17 (11), 3596-3602 1999
  4. Borow km , henderson ic , neuman a et al 1983 : assessment of left ventricular contractility in patients receiving doxorubicin.ann intern med 99:750,1983.
  5. Ben-Horin S, Bank I, Guetta V, et al 2006 :. Large symptomatic pericardial effusion as the presentation of unrecognized cancer: a study in 173 consecutive patients undergoing pericardiocentesis.Medicine (Baltimore). 2006 Jan. 85(1):49-53. [Medline].  malignant effusion
  6. Baijens LW, Manni JJ 2006. Paraneoplastic syndromes in patients with primary malignancies of the head and neck: four cases and a review of the literature. Eur Arch Otorhinolaryngol. 2006;263:32-36 [PubMed]
  7. Benjamin RS 1995 . Rationale for the use of mitoxantrone in the older patient: cardiac toxicity. Semin Oncol.1995; 22: 11–13.
  8. Bedetti G et al 2006. Evaluation of ultrasound lung comets by hand-held echocardiography Cardiovascular Ultrasound 2006, 4:34 doi:10.1186/1476-7120-4-34
  9. Cersosimo RJ 2003 :. Monoclonal antibodies in the treatment of cancer, part 2.Am J Health Syst Pharm. 2003
  10. Cobleigh MA, Langmuir VK, Sledge GW, et al.2003: A phase I/II dose-escalation trial of bevacizumab in previously treated metastatic breast cancer.SeminOncol. 2003; 30:
  11. Cerqueira M.D., Weissman N.J., Dilsizian V.2002 : Standardized myocardial segmentation, nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association.2002;105:539. [PubMed]
  12. Dresdale A, Bonow RO, Wesley et al.( 1983): Prospective evaluation of doxorubicin-induced cardiomyopathy resulting from postsurgical adjuvant treatment of patients with soft tissue sarcomas. Cancer;52:51-60
  13. Danias PG, Pipilis AG Hellenic et al . 2007 : Superior vena cava syndrome: 1757-2007 Nov-Dec; 48(6):366-7.[PubMed] [Ref list]
  14. Frickhofen N, Beck FJ, Jung B, et al 2002. Capecitabine can induce acute coronary syndrome similar to 5-fluorouracil. Ann Oncol. 2002
  15. Foster re , johnson db , barilla f , et al 1997,, angiotensen converting enzyme inhibitor affects left ventricular mass in patients with ejection >40 % after acute myocardial infarction j am Coll cardiol 1997 29-29-54
  16. Frishman WH, Sung HM, Yee HC,et al .( 1997) : Cardiovascular toxicity with cancer chemotherapy. Curr Probl Cancer;21:301-360.
  17. Gopal AS, Shen Z, Sapin PM, et al 1995 : Assessment of cardiac function by three-dimensional echocardiography compared with conventional noninvasive methods DL 1995 Aug 15; 92(4):842-53.[PubMed] [Ref list]
  18. Hanrahan EO, Gonzalez-Angulo AM, Giordano SH, et al 2007 Overall survival and cause-specific mortality of patients with stage T1a, bN0M0 breast carcinoma. J Clin Oncol 2007;25:4952-4960.
  19. Jurcut R, Wildiers H, Ganame J, et al 2008 : Detection and monitoring of cardiotoxicity-what does modern cardiology offer?Support Care Cancer. 2008;16(5):437–445. [PubMed]
  20. Jensen BV, Skovsgaard T, Nielsen SL 2002 :. Functional monitoring of Anthracycline cardiotoxicity: a prospective, blinded, long-term observational Study of outcome in 120 patients. Ann Oncol 2002;13: 699–709
  21. Kilickap S, Barista I, Akgul E et al.( 2005):ctnt can be a useful marker for early detection of anthracycline cardiotoxicityann Oncol;16:798– 801
  22. Krupicka J, Markova J, Pohlreich et al 2002 : Echocardiographic evaluation of acute cardiotoxicity in the treatment of Hodgkin disease according to the German Hodgkin's Lymphoma Study Group. Leuk Lymphoma 2002, 43:2325-2329.
  23. Keefe DL 2001: . Anthracycline-induced cardiomyopathy. Semin Oncol2001;28:2–7.
  24. Lind M.J., M.J. (2008). "Principles of cytotoxic chemotherapy".Medicine. 36 (1): 19–23. doi:1016/j.mpmed.2007.10.003
  25. Liu YQ, Yang L, Tian et al 2007, "Podophyllotoxin: current perspectives".Curr Bioactive Compounds. 3 (1): 37–66.
  26. Lang RM1,Bierig M, Devereux RB et al 2005 , Chamber Quantification Writing Group; American Society of Echocardiography's Guidelines and Standards Committee; Europ  PMID:16376782 DOI:1016/j.echo.2005.10.005
  27. Lioyd-Jones DM,Leip EP, Larson MG, et al 2006 : Prediction of lifetime risk for cardiovascular disease by risk factor burden at 50 years of age.  2006; 113: 791-798
  28. Meinardi MT, Gietema JA, van der Graaf WT, et al.2000: Cardiovascular morbidity in long-term survivors of metastatic testicular cancer.J ClinOncol. 2000; 18:
  29. Mellstedt, H 2003 :. Monoclonal antibodies in human cancer. DrugsToday (Barc.), 2003, 39(Suppl C), 1-16.104 -2011
  30. Nitiss JL (May 2009)."Targeting DNA topoisomerase II in cancer chemotherapy".Nature Reviews. Cancer. 9 (5): 338–50. doi:1038/nrc2607. PMC 2748742..PMID 19377506.
  31. Octavia Y, Tocchetti CG, Gabrielson KL, et al 2012 : Doxorubicin-induced cardiomyopathy: from molecular mechanisms to therapeutic strategies. J Mol Cell Cardop; 2012; 52:1213-1225..
  32. Parker WB (Jul 2009)."Enzymology of purine and pyrimidine antimetabolites used in the treatment of cancer". Chemical Reviews. 109 (7): 2880–93.doi:1021/cr900028p. PMC 2827868 . PMID 19476376
  33. Picard MH, Popp RL, Weyman AE 2008 :, Assessment of left ventricular function by echocardiography: a technique in evolution,J Am Soc Echocardiogr, 2008;21(1) :14–21. Crossref | PubMed
  34. Segers, V. Tchana-Sato, H.A. Leather, et al.2003 :Determinants of left ventricular preload-adjusted maximal powerAm J Physiol Heart Circ Physiol, 284 (2003), pp. H2295–H2301.
  35. Pein f, sakiroglu o, dahan m, lebidois et al 2004 : Cardiac abnormalities 15 years andMore after adriamycin therapy in 229 childhood survivors of a solid tumour at the institut gustave roussy. Br j cancer. 2004;91:37–44. Doi:
  36. Rajkumar SV, Hayman S, Gertz MA,et al 2002 : . Combination therapy with thalidomide plus dexamethasone for newly diagnosed myeloma.J Clin Oncol 2002; 20: 4319–4323.  | PubMed  |
  37. Schultz PN, Beck ML, Stava C, et al 2003. Health profiles in 5836 long-term cancer survivors. Int J Cancer.2003; 104: 488–495.CrossRefMedline
  38. Senior,R.et,al.2009 Contrast echocardiography: evidence-based recommendations by European Association of Echocardiography.  J. Echocardiogr. 10, 194–212 (2009).
  39. Senior r, janardhanan r, jeetley p (2005) myocardial contrast echocardiography for distinguishing ischemic from nonischemic first-onset acute heartfailure: insights into the mechanism of acute heart failure. Circulation 112:1587–1593pubmedcrossref oh jae k ,james b seward , jamil tajik,, the echo manual 20060-7817-4853-4
  40. Sepplet IM 2007. All intensivists need echocardiography skills in the 21st century. Critical Care and Resuscitation 2007; 9: 286 – 288
  41. Svoboda, M. (2011). Malignant pericardial effusion and cardiac tamponade (cardiac and pericardial symptoms). In I. N. Olver (Ed.),The MASCC textbook of cancer supportive care and survivorship (pp. 83–93). New York: Springer
  42. Shakir k,  (2009) : Chemotherapy Induced Cardiomyopathy: Pathogenesis, Monitoring and Management J clin Med;19:129
  43. Singal, PK, Iliskovic, N.( 1998): Doxorubicin-induced cardiomyopathy. N Engl J Med; 339:900.
  44. Swain SM, Whaley FS, Gerber MC et al (1997): Cardioprotection with dexrazoxane for doxorubicin-containing therapy in advanced breast cancer. J Clin Oncol 1997; 15: 1318–1332.
  45. Salvatorelli E, Menna P, Cantalupo E, et al 2015 :The concomitant management of cancer therapy and cardiac therapy. Biochim Biophys Acta. 1848;2015:2727–37.Google Scholar
  46. Teicher BA, Chari RV (2011) Antibody conjugate therapeutics: challenges and potential. Clin Cancer Res17(20): 6389–6397. [PubMed]
  47. Thomas jd and popovic zb (2006): Assessment of ventricular function by cardiac ultrasound. The clinical impact of echocardiography and its future directions. Am J Coll Cardiol 4:2012-2025.
  48. Vignon P 2007 . Focussed training for goal oriented hand held echocardiography performed by non cardiologist residents in the intensive care unit. Intensive Care Med. 2007; 33: 1795 - 1799
  49. Viellard Baron 2008 . Echocardiography in the intensive care unit: from evolution to revolution? Intensive Care Med. 2008; 34: 243 – 249
  50. van Dalen EC, van den Brug M, Caron HN, et al 2006 : Anthracycline-induced cardiotoxicity: comparison ofrecommendations for monitoring cardiac function during therapy in paediatric oncology trials. Eur J Cancer 42:3199-3205, 2006
  51. Von Hoff, DD, Layard, MW, Basa, P, et al.( 1979):Risk factors for doxorubicin-induced congestive heart failure. Ann Intern Med; 91:710 .
  52. Wang TJ, Evans JC, Benjamin EJ, et al. 2003 Natural history of asymptomatic left ventricular systolic dysfunction in the community. 2003;108(8):977–982. [PubMed]
  53. Yancey RS, Talpaz M1982 . Vindesine-associated angina and ECG changes.Cancer Treat Rep.; 66: 587
  54. Yeh, ET, Tong, AT, Lenihan, DJ, et al.( 2004): Cardiovascular complications of cancer therapy: diagnosis, pathogenesis, and management. Circulation; 109:3122.                                                                                                    

[Sherif mostafa ahmed hafiz, Saad Mahmoud Amaar, Reda Bayomy Bastawesy, Mohamed Mahrous Ali and Hala Aziz Shokralla. (2017); STUDY THE EFFECT OF CHEMOTHERAPY ON THE CARDIAC FUNCTION. Int. J. of Adv. Res. 5 (Feb). 2519-2527] (ISSN 2320-5407). www.journalijar.com

sherif mostafa haafiz

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Article DOI: 10.21474/IJAR01/3435      
DOI URL: https://dx.doi.org/10.21474/IJAR01/3435

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