CORRESPONDENCE: LETTER TO THE EDITOR
Early Breast Cancer Therapy and Cardiovascular Injury
Laurel Steinherz, MD, FAAP, FACC*
* Director of Pediatric Cardiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10021 (Email: steinhel{at}mskcc.org).
The paper by Jones et al. (1) provides an excellent review of the cardiovascular toxicity incurred during treatment for breast cancer. Late cardiotoxicity from anthracyclines has been recognized in survivors of childhood cancer (2) and is more recently being addressed in survivors of breast cancer. The section by Jones et al. on "Prevention and/or Treatment" contains many important approaches. It is surprising, however, that dexrazoxane is not mentioned.
Dexrazoxane was shown in the 1980s to afford protection from cardiotoxicity in women with breast cancer (3). Its use was limited after a multicenter trial, in advanced breast cancer, reported by Swain et al, confirmed cardioprotection, but showed, in 1 of the 5 study arms, a better tumor response in the control patients compared with those treated with dexrazoxane (4). As a result, the indication for breast cancer was restricted to patients who had already received 300 mg/m2 doxorubicin, pending further trials.
Further trials were subsequently conducted in patients with pediatric cancers, including Ewing’s sarcoma, osteosarcoma, Hodgkin’s lymphoma, and leukemia. These trials demonstrated cardioprotection, with no decrease in anticancer efficacy, when dexrazoxane was added to chemotherapeutic protocols. It is therefor used with initial therapy in pediatric patients. It has allowed treatment with cumulative doxorubicin doses up to 600 mg/m2, without cardiac failure (5). It is, therefore, time for the use of dexrazoxane to be investigated again in women with breast cancer during initial treatment, to provide them with protection against future cardiotoxicity.
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References
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- Jones LW, Haykowsky MJ, Swartz JJ, Douglas PS, Mackey JR. Early breast cancer therapy and cardiovascular injury J Am Coll Cardiol 2007;50:1435-1441.[Abstract/Free Full Text]
- Steinherz LJ, Steinherz PG, Tan CTC, Heller G, Murphy ML. Cardiotoxicity 4-20 years after completing anthracycline therapy JAMA 1991;266:1672-1677.[Abstract]
- Speyer JL, Gree, MD, Kramer E, et al. Protective effect of the bispiperazinedione ICRF-187 against doxorubicin-induced cardiac toxicity in women with advanced breast cancer N Engl J Med 1988;319:745-752.[Abstract]
- Swain SM. Adult multicenter trials using dexrazoxane to protect against cardiac toxicity Semin Oncol 1998;25:43-47.[ISI][Medline]
- Schwartz CL, Wexler L, Devidas M, et al. P9754 therapeutic intensification in non-metastatic osteosarcoma: a COG trial J Clin Onc 2004;22:802S.
Related Article
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Reply
- Lee W. Jones, Mark J. Haykowsky, Pamela S. Douglas, and John R. Mackey
J. Am. Coll. Cardiol. 2008 51: 1235.
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