Chemotherapy-induced cardiotoxicity in children

Area of Science:

• Cardio-oncology
• Cancer therapy
• Cardiovascular complications

Background:

• Chemotherapy, particularly anthracyclines, causes progressive and often irreversible cardiac damage in cancer survivors.
• The increasing number of cancer survivors highlights the growing burden of treatment-related cardiovascular morbidity and mortality.
• Primary prevention strategies, including dose limitation and cardioprotective agents, are crucial for mitigating cardiotoxicity.

Purpose of the Study:

• To review cardiotoxic chemotherapeutic agents and the pathophysiology of anthracycline-induced cardiotoxicity.
• To discuss the clinical presentation, progression, and prevention of childhood anthracycline cardiotoxicity.
• To evaluate the role of dexrazoxane as a cardioprotectant and explore the potential of cardio-oncology.

Main Methods:

• Literature review of cardiotoxic chemotherapeutic agents.
• Analysis of pathophysiology and clinical manifestations of anthracycline cardiotoxicity.
• Evaluation of evidence for preventive strategies, including dexrazoxane.

Main Results:

• Certain factors (cumulative dose, dose rate, female sex, age, irradiation) increase cardiotoxicity risk.
• Dexrazoxane is a supported cardioprotectant for anthracycline chemotherapy.
• Evidence-based guidelines for diagnosing and treating cancer therapy-induced cardiovascular complications are lacking.

Conclusions:

• No anthracycline dose is entirely 'safe' for long-term cardiovascular health.
• Personalized cancer therapy, informed by mechanistic understanding and genetic factors, can limit cardiotoxicity.
• Further research is needed to establish diagnostic and treatment protocols for cancer therapy-induced cardiovascular complications.