Swain SM, Whaley FS, Gerber MC, et al: Delayed administration of dexrazoxane provides cardioprotection for patients with advanced breast cancer treated with ...
Correspondence
Reply to R. Steiner et al
AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST
We graciously acknowledge the expert opinion of Steiner and Hellmann1 regarding statements about cardioprotection during anthracycline-based chemotherapy. In our review,2 we did acknowledge that dexrazoxane was a therapeutic option for cardioprotection and referenced a major review on the use of cardioprotectants.3 Because our review was focused on late cardiac effects of cancer treatment, we were unable to carefully detail all of the relevant studies that potentially addressed early or acute cardiotoxicity from anthracyclines, although we do agree conceptually with Steiner and Hellmann that prevention is the best strategy. Furthermore, we recognize that American Society of Clinical Oncology 2008 Clinical Practice Guideline4 suggests the use of dexrazoxane in specific adult patients (patients with breast cancer who have received ⬎ 300 mg/m2 of anthracyclines) on the basis of work from Swain5,6 and others.7,8 Additionally, Lipshultz9 has published authoritative reports on the effective use of dexrazoxane in childhood leukemia. However, it is certainly our observation and that of others10 that dexrazoxane has a significantly limited use in adult patients who receive anthracyclines.11 This may be in part a result of attenuation of the cancer efficacy of anthracyclines or the potential concern of late effects, such as secondary leukemia.12 In fact, the use of dexrazoxane in children is not recommended in Europe.13 Conversely, angiotensinconverting enzyme inhibitors and carvedilol are ubiquitously used clinically, and their long-term safety is well established. These classic cardiac medications are known to be cardioprotective with chemotherapy,14,15 especially anthracyclines, and the ease of administering this medication(s) during chemotherapy is understood. We agree that no study has directly compared dexrazoxane cardioprotection with angiotensin-converting enzyme inhibitors or carvedilol in the context of anthracycline chemotherapy, and it seems highly unlikely that such a study will be performed.
REFERENCES
Daniel Lenihan Vanderbilt University Medical Center, Nashville, TN
Daniela Cardinale European Institute of Oncology, Milan, Italy
The author(s) indicated no potential conflicts of interest.
1. Steiner R, Hellmann K: Dexrazoxane prevention of anthracycline cardiomyopathy. J Clin Oncol 31:1379, 2013 2. Lenihan DJ, Cardinale DM: Late cardiac effects of cancer treatment. J Clin Oncol 30:3657-3664, 2012 3. van Dalen EC, Caron HN, Dickinson HO, et al: Cardioprotective interventions for cancer patients receiving anthracyclines. Cochrane Database Syst Rev 6:CD003917, 2011 4. Hensley ML, Hagerty KL, Kewalramani T, et al: American Society of Clinical Oncology 2008 clinical practice guideline update: Use of chemotherapy and radiation therapy protectants. J Clin Oncol 27:127-145, 2009 5. Swain SM, Whaley FS, Gerber MC, et al: Delayed administration of dexrazoxane provides cardioprotection for patients with advanced breast cancer treated with doxorubicin-containing therapy. J Clin Oncol 15:13331340, 1997 6. Swain SM, Whaley FS, Gerber MC, et al: Cardioprotection with dexrazoxane for doxorubicin-containing therapy in advanced breast cancer. J Clin Oncol 15:1318-1332, 1997 7. Speyer JL, Green MD, Zeleniuch-Jacquotte A, et al: ICRF-187 permits longer treatment with doxorubicin in women with breast cancer. J Clin Oncol 10:117-127, 1992 8. Lopez M, Vici P, Di Lauro K, et al: Randomized prospective clinical trial of high-dose epirubicin and dexrazoxane in patients with advanced breast cancer and soft tissue sarcomas. J Clin Oncol 16:86-92, 1998 9. Lipshultz SE, Rifai N, Dalton VM, et al: The effect of dexrazoxane on myocardial injury in doxorubicin-treated children with acute lymphoblastic leukemia. New Engl J Med 351:145-153, 2004 10. Ewer MS, Von Hoff DD, Benjamin RS: A historical perspective of anthracycline cardiotoxicity. Heart Fail Clin 7:363-372, 2011 11. Swain SM, Vici P: The current and future role of dexrazoxane as a cardioprotectant in anthracycline treatment: Expert panel review. J Cancer Res Clin Oncol 130:1-7, 2004 12. Tebbi CK, London WB, Friedman D, et al: Dexrazoxane-associated risk for acute myeloid leukemia/myelodysplastic syndrome and other secondary malignancies in pediatric Hodgkin’s disease. J Clin Oncol 25:493-500, 2007 13. European Medicines Agency: European Medicines Agency recommends restricting the use of dexrazoxane-containing medicines. http://www.ema.europa.eu/ema/ index.jsp?curl⫽pages/medicines/human/public_health_alerts/2011/06/ human_pha_detail_000031.jsp&mid⫽WC0b01ac058001d126 14. Cardinale D, Colombo A, Sandri MT, et al: Prevention of high-dose chemotherapy-induced cardiotoxicity in high-risk patients by angiotensinconverting enzyme inhibition. Circulation 114:2474-2481, 2006 15. Kalay N, Basar E, Ozdogru I, et al: Protective effects of carvedilol against anthracycline-induced cardiomyopathy. J Am Coll Cardiol 48:22582262, 2006
DOI: 10.1200/JCO.2012.48.1788; published online ahead of print at www.jco.org on February 25, 2013 ■ ■ ■
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