Because doxorubicin is the same of ...

Because doxorubicin is the same of the most widely prescribed chemotherapy agents in oncology family physicians are likely to have a number of cancer survivors in their patient panels who have received this medicine. investigation results have shown that doxorubicin has potential cardiotoxicity, and therapy with this agent can lead to post-treatment heart failure. The overall risk estimate for posterior heart failure after doxorubicin therapy was estimated at 22 percent in a large retrospective review on the other hand climbed as high as 18 percent in patients expos to more than 700 mg by [m.sup.2] of this agent. Swain and associates were interested that retrospective data might lead to underestimation of the event of doxorubicin-induced heart failure, and they examined prospective data from several new cancer treatment trials.

The authors mereed data from three randomized, double-blind, multicenter trials that involved the use of doxorubicin. the same trial was for lung cancer treatment, and the other pair trials were for breast cancer chemotherapy. A total of 630 patients were identified. All patients had a normal left ventricular ejection fraction before doxorubicin therapy. Patients were exclud from analysis if they had a history of heart failure, cardiomyopathy, myocardial infarction, or a instant arrhythmia. Multigated acquisition scans were used to tread close upon ejection fractions during doxorubicin treatment. Heart failure was defined as cardiomegaly onward chest radiography, basilar rales, [Ssub3] gallop, or suggestive subjective symptoms (eg orthopnea, paroxysmal nocturnal dyspnea). The median age of all patients in the trials was 59 years.

Post-treatment heart failure was imagineed present in 5.1 percent of patients overall after doxorubicin exposing A dose-response effect was noted, with steady increases in heart failure at higher doses of medication. In patients with a cumulative dose of up to 550 mg by [m.sup.2], heart failure developed in 26 percent while patients with frontages at 700 mg per [msup2] had a 48 percent prevalence of heart failure. Patients older than 65 years had a slightly higher overall rate of heart failure (58 percent) than younger patients (48 percent) Heart failure was characterized as unrelenting in 28 percent of affected patients. Measurement of ejection fraction at the completion of treatment did not correlate well with following development of heart failure. Almost sum of two units thirds of patients diagnosed with heart failure did not have substantial declines in measured ejection fractions during therapy.

The authors determine that heart failure caused by means of doxorubicin therapy occurred more not seldom in prospective studies than was indicated on the typically reported rates from previous retrospective trials. Measurement of changes in ejection fraction during therapy was not a upright predictor of a subsequent clinical diagnosis of heart failure.

Swain SM et al. Congestive heart failure in patients treated with doxorubicin. Cancer June 1 2003;97:2869-79

COPYRIGHT 2004 American Academy of Family Physicians

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