Anthracycline-induced cardiotoxicity: prospective cohort study from Pakistan

Area of Science:

• Pediatric Oncology
• Cardiology
• Pharmacology

Background:

• Childhood malignancies often require anthracycline chemotherapy, a potent class of anticancer drugs.
• Anthracyclines, such as doxorubicin and daunorubicin, are known for their cardiotoxic potential.
• Monitoring cardiac function is essential in pediatric patients undergoing anthracycline treatment.

Purpose of the Study:

• To determine the incidence of acute and early-onset chronic progressive cardiotoxicity in children under 16 treated with anthracyclines.
• To evaluate cardiac dysfunction within one month and one year of anthracycline chemotherapy in pediatric cancer patients.
• To identify risk factors associated with anthracycline-induced cardiotoxicity in a Pakistani tertiary care setting.

Main Methods:

• A prospective cohort study was conducted at Aga Khan University, Pakistan.
• 110 children (aged 1 month to 16 years) receiving anthracycline chemotherapy were enrolled.
• Echocardiographic evaluations were performed at baseline, 1 month, and 1 year to assess cardiac function (systolic and diastolic).

Main Results:

• 14% of children developed cardiac dysfunction within one month, and 25% within one year.
• Diastolic dysfunction was common, seen in 66.6% acutely and 43% chronically, with combined systolic and diastolic dysfunction in 33.3% and 57%, respectively.
• Severe cardiotoxicity led to mortality in 6.4% of patients, with dose-related toxicity observed (p<0.001) and increased risk with combination therapy (p=0.004).

Conclusions:

• The incidence of anthracycline-induced cardiotoxicity is high in pediatric cancer patients.
• Early detection and monitoring of cardiac dysfunction are critical.
• Long-term follow-up is essential to manage the late-onset manifestations of cardiotoxicity.