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J Am Coll Cardiol, 2008; 51:1235, doi:10.1016/j.jacc.2007.12.016
© 2008 by the American College of Cardiology Foundation
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CORRESPONDENCE: LETTER TO THE EDITOR

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Lee W. Jones, PhD*, Mark J. Haykowsky, PhD, Pamela S. Douglas, MD and John R. Mackey, MD

* Box 3624, Duke University Medical Center, Durham, North Carolina 27710 (Email: lee.w.jones{at}duke.edu).

We thank Dr. Steinherz for the important comments regarding the use of dexrazoxane as a prevention/treatment strategy for anthracycline-induced cardiotoxicity in cancer patients. The primary focus of our paper was to examine the risk of and preventive/treatment strategies for long-term global cardiovascular disease (CVD) as opposed to the specific entity of anthracycline-induced cardiotoxicity (1). We feel that this is important to stress because the risk of late-occurring CVD in women diagnosed with early breast cancer likely far exceeds the risk of symptomatic anthracycline-induced cardiac dysfunction during therapy. Clearly, prevention/treatment of cardiac toxicity is of major clinical importance in breast and several other cancer populations, as highlighted by Dr. Steinherz. Further, acute and delayed cardiac toxicity likely contribute to the risk of late-occurring CVD as a component of the "multiple-hit" hypothesis as described in our paper (1). To this end, we agree with Dr. Steinherz that clinical trials of dexrazoxane are required in women receiving chemotherapy in the early stages of disease. However, we wanted to highlight strategies for the treatment of risk factors for the global prevention of CVD in women (e.g., lifestyle modification in conjunction with pharmacotherapy) which has not, in our opinion, received adequate attention in oncology.

Finally, to our knowledge, dexrazoxane has only been investigated and approved by the Food and Drug Administration among breast cancer patients in the metastatic (advanced) setting who have received a cumulative dose of 300 mg/m2 (2). Given that the focus of our paper was cardiovascular injury among women diagnosed with early-stage disease, we felt inclusion of this approach was not warranted.


   References
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 References
 

  1. 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]
  2. Hensley ML, Schuchter LM, Lindley C, et al. American Society of Clinical Oncology clinical practice guidelines for the use of chemotherapy and radiotherapy protectants J Clin Oncol 1999;17:3333-3355.[Abstract/Free Full Text]

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Early Breast Cancer Therapy and Cardiovascular Injury
Laurel Steinherz
J. Am. Coll. Cardiol. 2008 51: 1235. [Full Text] [PDF]




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