Difficulties of preventing cardiotoxicity in patients with lymphomas and those receiving anthracyclines treatment
- 作者: Kulieva A.1, Emelina E.1, Gendlin G.1, Nikitin I.1, Baryakh E.1, Misyurina E.1
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隶属关系:
- N.I. Pirogov Russian National Research Medical University
- 期: 卷 26, 编号 6 (2020)
- 页面: 351-358
- 栏目: Clinical medicine
- URL: https://journals.rcsi.science/0869-2106/article/view/65012
- DOI: https://doi.org/10.17816/0869-2106-2020-26-6-351-358
- ID: 65012
如何引用文章
详细
Background. The percentage of short-term and long-term consequences of chemoradiation therapy and their detection increases with the increase in the survival cancer patient rate. Currently, enalapril, carvedilol, and low-dose statins are recognized as drugs that prevent cardiotoxicity from chemoradiation therapy.
The work aimed to study the cardioprotective treatment tolerability in patients with lymphomas receiving chemotherapeutic treatment with the inclusion of anthracycline antibiotics.
Materials and methods. We examined 47 patients with Hodgkin’s and non-Hodgkin’s lymphomas, who received treatment with chemotherapeutic agents, including anthracycline antibiotics (doxorubicin and epirubicin). Study inclusion criteria were anthracycline antibiotic use in specific treatment regimens for the underlying lymphoproliferative disease and signed informed consent. At the start of treatment and after the first cycles of chemotherapy, the indicators of electrocardiography, echocardiography, and blood pressure measurements at home with constant monitoring were assessed. And then, the general condition of the patients, the tolerability of the main and preventive treatments, and adherence to therapy were studied during the preventive treatment with carvedilol and/or enalapril.
Results. Drug titration was difficult because of poor tolerability, asthenia increase, and low blood pressure, and in some cases, it led to self-withdrawal of drugs.
The heart rate during preventive treatment decreased in both groups of patients, but it was statistically insignificant and did not reach the target values. This result was due to the rapid decrease in systolic blood pressure, which prevented the titration of enalapril and carvedilol to the target dosages.
Conclusion. Adherence to preventive therapy throughout chemotherapy remained low. When assessing the tolerability of enalapril and carvedilol at the initial stages of titration, there were difficulties because of the rapid decrease in blood pressure before reaching the target heart rate values.
作者简介
Aygyun Kulieva
N.I. Pirogov Russian National Research Medical University
Email: onistella@mail.ru
ORCID iD: 0000-0002-8576-3159
俄罗斯联邦, 117997, Moscow
Elena Emelina
N.I. Pirogov Russian National Research Medical University
Email: eei1210@mail.ru
ORCID iD: 0000-0002-3100-8342
MD, PhD
俄罗斯联邦, 117997, MoscowGennady Gendlin
N.I. Pirogov Russian National Research Medical University
编辑信件的主要联系方式.
Email: rgmugt2@mail.ru
ORCID iD: 0000-0002-7846-1611
MD, PhD, DSc, Professor
俄罗斯联邦, 117997, MoscowIgor’ Nikitin
N.I. Pirogov Russian National Research Medical University
Email: igor.nikitin.64@mail.ru
MD, PhD, DSc, Professor
俄罗斯联邦, 117997, MoscowElena Baryakh
N.I. Pirogov Russian National Research Medical University
Email: ebaryakh@icloud.com
ORCID iD: 0000-0001-6880-9269
MD, PhD, DSc, Professor
俄罗斯联邦, 117997, MoscowElena Misyurina
N.I. Pirogov Russian National Research Medical University
Email: misyurina_elena@mail.ru
ORCID iD: 0000-0003-2419-4850
MD, PhD
俄罗斯联邦, 117997, Moscow参考
- Kaprin AD, Starinskii VV, Petrova GV. Malignant neoplasms in Russia in 2018 (morbidity and mortality). Moscow: MNIOI im. P.A. Herzen branch of the Federal State Budgetary Institution “National Medical Research Center of Radiology” of the Ministry of Health of Russia; 2019. 250 p. (In Russ).
- Rosen MR, Myerburg RJ, Francis DP, Cole GD, Marban E. Translating stem cell research to cardiac disease therapies: pitfalls and prospects for improvement. J Am Coll Cardiol. 2014;64(9):922–937. doi: 10.1016/j.jacc.2014.06.1175.
- Mariotto AB, Yabroff KR, Shao Y, Feuer EJ, Brown ML. Projections of the cost of cancer care in the United States: 2010-2020. J Natl Cancer Inst. 2011;103(2):117–128. doi: 10.1093/jnci/djq495.
- Koelwyn GJ, Jones LW, Moslehi J. Unravelling the causes of reduced peak oxygen consumption in patients with cancer: complex, timely, and necessary. J Am Coll Cardiol. 2014;64(13):1320–1322. doi: 10.1016/j. jacc.2014.07.949.
- Biasillo G, Cipolla CM, Cardinale D. Cardio-oncology: gaps in knowledge, goals, advances, and educational efforts. Curr Oncol Rep. 2017;19(8):55.
- Bansal N, Adams MJ, Ganatra S, Colan SD, Aggarwal S, Steiner R, et al. Strategies to prevent anthracycline-induced cardiotoxicity in cancer survivors. Cardiooncology. 2019;5:18. doi: 10.1186/s40959-019-0054-5.
- Zamorano JL, Lancellotti P, Rodriguez Muñoz D, Aboyans V, Asteggiano R, Galderisi M, et al. 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). Eur Heart J. 2016;37(36):2768–2801. doi: 10.1093/eurheartj/ehw211.
- Armstrong GT, Oeffinger KC, Chen Y, Kawashima T, Yasui Y, Leisenring W, et al. Modifiable risk factors and major cardiac events among adult survivors of childhood cancer. J Clin Oncol.2013;31(29):3673–3680. doi: 10.1200/ JCO.2013.49.3205.
- Takami Y, Hoshino N, Kato Y, Sakurai Y, Amano K, Higuchi Y, et al. Recovery from anthracycline-induced cardiomyopathy with biventricular assist and valve repairs: a case report and literature review.Int J Artif Organs. 2018;41(7):413–417. doi: 10.1177/0391398818772497.
- Murtagh G, Lyons T, O’Connell E, Ballot J, Geraghty L, Fennelly D, et al. Late cardiac effects of chemotherapy in breast cancer survivors treated with adjuvant doxorubicin: 10-year follow-up. Breast Cancer Res Treat. 2016;156(3):501–506. doi: 10.1007/s10549-016-3781-4.
- Lenneman AJ, Wang L, Wigger M, Frangoul H, Harrell FE, Silverstein C, et al. Heart transplant survival outcomes for adriamycin-dilated cardiomyopathy. Am J Cardiol. 2013;111(4):609–612. doi: 10.1016/j.amjcard.2012.10.048.
- Tan L, Lyon AR. Role of biomarkers in prediction of cardiotoxicityduring cancer treatment. Curr Treat Options Cardio Med. 2018;20:55. doi: 10.1007/s11936-018-0641-z.
- Carrasco R, Ramirez MC, Nes K, Schuster A, Aguayo R, Morales M, et al. Prevention of doxorubicin-induced Cardiotoxicity by pharmacological non-hypoxic myocardial preconditioning based on Docosahexaenoic Acid (DHA) and carvedilol direct antioxidant effects: study protocol for a pilot, randomized, double-blind, controlled trial (CarDHA trial). Trials. 2020;21(1):137. doi: 10.1186/s13063-019-3963-6.
- Curigliano G, Lenihan D, Fradley M, Ganatra S, Barac A, Blaes A, et al. Management of cardiac disease in cancer patients throughout oncological treatment: ESMO consensus recommendations. AnnOncol. 2020;31(2):171–190. doi: 10.1016/j.annonc.2019.10.023.
- Markman TM, Markman M. Cardio-Oncology: mechanisms of cardiovascular toxicity. F1000Res. 2018;7:113. doi: 10.12688/f1000research.12598.1.
- Henriksen PA. Anthracyclinecardiotoxicity: an update on mechanisms, monitoring and prevention. Heart. 2018;104(12):971–977. doi: 10.1136/heartjnl-2017-312103.
- Lyon AR, Dent S, Stanway S, Earl H, Brezden-Masley C, Cohen-Solal A, et al. Baseline cardiovascular risk assessment in cancer patients scheduled to receive cardiotoxic cancer therapies: a position statement and new risk assessment tools from the Cardio-Oncology Study Group of the Heart Failure Association of the European Society of Cardiology in collaboration with the International Cardio-Oncology Society. Eur J Heart Fail. 2020;22(11):1945–1960. doi: 10.1002/ejhf.1920.
- Larsen CM, Mulvagh SL. Cardio-oncology: what you need to know now for clinical practice and echocardiography. Echo Res Pract. 2017;4(1):R33–R41. doi: 10.1530/ERP-17-0013.
- Vejpongsa P, Yeh ET. Prevention of anthracycline-induced cardiotoxicity: challenges and opportunities. J Am Coll Cardiol. 2014;64(9):938–945. doi: 10.1016/j.jacc.2014.06.1167.
- Blanter JB, Frishman WH. The preventive role of ace inhibitors/angiotensin-ii receptor blockers and beta-adrenergic blockers in anthracycline and trastuzumab-induced cardiotoxicity. Cardiol Rev. 2019;27(5):256–259. doi: 10.1097/CRD.0000000000000252.
- Cardinale D, Ciceri F, Latini R, Franzosi MG, Sandri MT, Civelli M, et al. Anthracycline-induced cardiotoxicity: a multicenter randomised trial comparing two strategies for guiding prevention with enalapril: The International CardioOncology Society-one trial. Eur J Cancer. 2018;94:126–137. doi: 10.1016/j.ejca.2018.02.005.
- Muratov RM, Babenko SI, Sachkov AS, Soboleva NN, Andrianova EA. Post radiotherapy lesions of the heart valves. Principles of diagnosis and results of treatment. Cardiology. 2019;59(3):36–42. (In Russ). doi: 10.18087/cardio.2019.3.10239.
- Gilchrist SC, Barac A, Ades PA, Alfano CM, Franklin BA, Jones LW, et al. Cardio-oncology rehabilitation to manage cardiovascular outcomes in cancer patients and survivors. A scientific statement from the American Heart Association. Circulation. 2019;139(21):e997–e1012. doi: 10.1161/CIR.0000000000000679.
- Ryazankina AA, Belyaev AM. Determination of a vector of therapy for weakness in incurable breast cancer patients based on the level of inflammatory response. Voprosy oncologii. 2016;62(1):104–111. (In Russ).