Clinical management of doxorubicin cardiomyopathy in chemotherapy patients


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Valerie A.J Potter1
1Lister Hospital, Herts, UK

Background

Doxorubicin is an effective anthracycline used in adults and children in a range of malignancies. However, a serious adverse effect is cardiomyopathy leading to heart failure. This may develop acutelyorchronically. Once established, doxorubicin cardiotoxicity is a lethal condition with significant mortality. There are few guidelines on the treatment of doxorubicin-induced heart failure and no specific treatment exists. Preventionis important with the development of stategies to reduce risk. In managing heart failure, typical medications used in other forms of heart failure should be employed.

Method

The PubMed andMEDLINE databasesand Cochrane Database of Systematic Reviews were searched systematically. Search terms included anthracyclines, doxorubicin, cardiomyopathy, heart failure and cancer. Articles and related links were reviewed.

Results

Clinical management of doxorubicin-induced heart failure is difficult as data is lacking. Prevention remains important with screening for risk factors including high cumulated dose, ventricular dysfunction, ischaemic heart disase, advancing age and children. Maximum doses of doxorubicin have been recommended and work is on-going regarding the use of docorubicin analogues, alternative drug delivery modalities and co-administration of cardioprotective agents. It is generally recommended to stop the chemotherapy when heart failure develops and to manage the condition with the agents used in non-ischaemic cardiomyopathies e.g. diuretics, beta-blockers, aldosterone antagonist, ACE inhibitors. Cardiac transplant and ventricular assist device implantation are surgical options but are not without considerable risks.

Conclusion

Doxorubicin-induced heart failure is rare but associated with significant mortality. Patients treated with doxocrubicin should be screened during and after treatment. Although few studies exist in the treatment of this cardiomyopathy, medical therapy should include those agents established for other forms of heart failure and it is likely these are effective. Previously reported poor response may have been the result of underuse of modern drugs and delays in treatment, highlighting the importance of monitoring patients treated with doxorubicin and adopting an aggressive approach to heart failure where appropriate.