1 / 12

Anthracycline induced Cardiomyopathy

Anthracycline induced Cardiomyopathy. AM Report December 11 2009. Chemotherapy and Cardiotoxicity. Anthracyclines Herceptin Antimetabolites 5-fluorouracil - coronary vasospasm Fludarabine - high dose for BMT conditioning Vinca alkaloids - hypertension, myocardial ischemia

diza
Download Presentation

Anthracycline induced Cardiomyopathy

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Anthracycline induced Cardiomyopathy AM Report December 11 2009

  2. Chemotherapy and Cardiotoxicity • Anthracyclines • Herceptin • Antimetabolites • 5-fluorouracil - coronary vasospasm • Fludarabine - high dose for BMT conditioning • Vinca alkaloids - hypertension, myocardial ischemia • Taxanes - conduction abnormalities • Cyclophosphamide - cardiomyopathy • Bleomycin - pericarditis • Mitomycin C - heart failure • Monoclonal antibodies

  3. History of Anthracycline use • Fermentation product of Streptomyces peucetius • Daunomycin and doxorubicin devolped in 1960s • Clinical Uses • breast and esophageal carcinomas • osteosarcoma, • Kaposi's sarcoma and soft-tissue sarcomas • Hodgkin's and non-Hodgkin's lymphomas Doxorubicin

  4. Mechanism • Therapuetic • Intercalating between base pairs of the DNA/RNA • Inhibits topoiosomerase II enzyme • Cardiotoxicity • Production of toxic oxygenﾊfree radicals and an increase in oxidative stress • Loss of myofibrils and the vacuolization of cytoplasm

  5. Risk Factors - Cumulative dose

  6. Risk Factors • Age • <3 years of age and >70 years of age • Previous/Concurrent Radiation • Concomitant chemotherapy • Herceptin and taxols • Bone Marrow Transplant • Cardiac Risk Factors

  7. Clinical Manifestations • Acute - during infusion to 1 week • Arrhythmias • Ventricular dysfunction • Pericarditis/myocarditis • Early - < 1 year • Dose-related cardomyopathy • Late

  8. Monitoring • Serial noninvasive monitoring of LVEF • Radionuclide angiography (MUGA) • Echocardiography • Exercise stress radionuclide ventriculography • Biomarkers • Serum troponins • BNP/pro-BNP • Endomyocardial Biopsy

  9. Monitoring • Normal EF • Baseline (prior to 100 mg/m2) • 2nd study after 250 to 300 mg/m2 • 3rd at 400-450 mg/m2 • Sequential studies prior to each additional dose • EF 30-50% • EF study prior to each dose • EF < 30% - recommend against initiating • Discontinue doxorubicin for decrease in EF >10% or absolute < 30%

  10. Prevention • Altering infusion protocol • Alternate anthracycline derivatives • Liposomal preparations • Dexrazoxane - metal-chelating agent • Beta-blockers • ACE inhibitors

  11. Prognosis and Treatment • Prognosis • Mortality rates of > 30% in early studies • Treatment • ACE inhibitors • Traditional Heart failure Management • Heart Transplant

  12. Refrences • Up-to-Date • Cancer Medicine 6 • CHEST February 1999 vol. 115 no. 2 569-571 • Schwartz, RG, McKenzie, WB, Alexander, J, et al. Congestive heart failure and left ventricular dysfunction complication doxorubicin therapy. Seven-year experience using serial radionuclide angiocardiography. Am J Med 1987; 82:1109. • Jannazzo A, Hoffman J, Lutz M. Monitoring of anthracycline-induced cardiotoxicity. Ann Pharmacother. 2008 Jan;42(1):99-104. • Appel JM, Nielsen D, Zerahn B, Jensen BV, Skagen K. Anthracycline-induced chronic cardiotoxicity and heart failure. Acta Oncol. 2007;46(5):576-80. • Singal PK, Iliskovic N. Doxorubicin-induced cardiomyopathy. N Engl J Med. 1998 Sep 24;339(13):900-5.

More Related