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Anthracyclines are highly potent anti-neoplastic agents that treat both solid and hematologic malignancies with great efficacy. However, the side effects associated with anthracycline use, such as congestive heart failure and cardiomyopathy, can greatly restrict their use.

In this supplement to Seminars in Oncology, leading experts in the fields of oncology, hematology, and cardiology contribute their considerable expertise regarding current clinical practice in the management of anthracycline-induced cardiotoxicity in patients with cancer. The supplement begins with a focus on the pathogenesis of cardiotoxicity induced by anthracyclines in adults, from a cardiologist’s perspective. Dr Elliot’s article highlights the deteriorating cardiac function that can occur with anthracycline use, even years after the cessation of treatment. This can culminate in significant damage in older patients, who are more prone to cardiac disease. Thus, to minimize cardiac damage, the importance of using preventive measures as soon as chemotherapy is initiated is emphasized.

Pediatric patients are particularly susceptible to anthracycline-induced cardiac damage, and an article by Dr Lipshultz within this supplement focuses on the key topic of cardiac injury during childhood caused by anthracycline and/or radiotherapy exposure. The use of high-dose anthracyclines in children with acute lymphoblastic leukemia – the most common of the childhood cancers from 2 years of age onward – has resulted in highly significant improvements in 5-year event-free survival over the past three decades. However, the cardiotoxic effects of such treatments may be irreversible, and can be exacerbated by radiotherapy. Nevertheless, numerous studies suggest that preventing cardiac functional deterioration is possible with the concomitant use during chemotherapy of drugs such as dexrazoxane.

Breast cancer is the second most common malignancy in women, and the consequences of anthracycline chemotherapy in patients with the disease are addressed here.¹ Anthracyclines significantly increase survival when used as part of adjuvant treatment in patients with breast cancer, and they have also been used with some success in the metastatic setting. However, the risk of life-threatening congestive heart failure is relatively high, particularly in older patients. Dr Jensen highlights the inadequacy of functional monitoring for predicting cardiotoxicity, and identifies promising future treatment options for the prevention of cardiac damage.

Finally, anthracycline-induced cardiotoxicity in hematologic malignancies is discussed by Dr Johnson. A disadvantage of anthracycline use in patients with hematologic malignancies is the potential for unpredictable and progressive cardiac damage, which can occur regardless of dose, and following just one round of treatment. This and other issues are addressed, including the consequences of congestive heart failure, with a focus on quality of life and strategies for minimizing cardiotoxicity.

The information contained in this supplement is intended as an overview of the issues surrounding anthracycline-induced cardiotoxicity. I hope that this will help clinicians in the development of practical solutions for the future management of their patients.

The experts who have contributed to this supplement discussed these issues at a roundtable meeting in London, UK, in November 2004. The meeting was sponsored by a grant from Chiron Biopharmaceuticals.

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Reference 

1. American Cancer Society Facts and Figures 2006. Available at http://www.cancer.org/docroot/STT/stt_0.asp (accessed April 13, 2006)
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