Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Study indicates heart damage from some cancer drugs worsens over the years

19.07.2006
Life-long monitoring important for patients treated by anthracylines say Dutch researchers

It is well documented that some anti-cancer drugs can damage the heart, but a long-term follow-up of children and young adults who had doxorubicin[1] treatment for bone tumours suggests that the damage gets progressively worse as the years go on.

In a study published on-line today (Thursday 20 July) in Annals of Oncology[2] researchers from the University Medical Centre at the University of Groningen in the Netherlands, say that all patients treated with drugs known as anthracyclines should have life-long cardiac monitoring.

Their study followed 22 patients, who had been treated with moderate or high doses of doxorubicin for osteogenic sarcomas or malignant fibrous histiocytomas, for a median time of 22 years (between 15 and 27.5 years). It is believed to be the longest prospective follow-up to evaluate heart function in children, adolescents and young adults treated with anthracylines.

The researchers found over a quarter had systolic dysfunction and nearly half had diastolic dysfunction and that this was a further deterioration in heart function compared to an earlier follow-up when fewer than one in ten had systolic dysfunction and less than a fifth had diastolic dysfunction.

Lead researcher Dr Inge Brouwer, from the subdivision of paediatric oncology at the centre, said: “We undertook this long-term study because – since it’s known that overt heart failure has been found in up to 5% of cancer survivors treated with anthracyclines – it was possible that subclinical abnormalities might be even more frequent. The natural course of subclinical abnormalities was largely unknown and it was unclear whether we could expect progressive cardiac deterioration.”

There were 31 long-term survivors in the original group of patients treated between 1977 and 1999. Most were children and adolescents but the age range was 10 to 38. All had cardiac assessment nine years after treatment. Twenty-nine were re-assessed 14 years after treatment, and 22 in the present round of assessment. Of the original group, one died from congestive heart failure; one from a second cancer; two – who were already known to have an abnormal heart function – were excluded because they had received thoracic radiotherapy for a second cancer; one had a terminal neurodegenerative disease and four refused to take part.

In addition to a physical examination and medical history the assessment involved blood tests and blood pressure measurements, Doppler echocardiography, a static ECG and 24-hour ECG monitoring during normal activities. Systolic and diastolic function tests showed how well the heart’s left chamber was pumping (systolic function) and relaxing (diastolic function).

Dr Brouwer said: “We found progressive impairment of systolic and diastolic function. We also found a deterioration in heart rate variability (HRV) in the 19 of the 22 patients whose HRV we were able to evaluate. HRV is the alteration in the beat-to-beat rate of the heart and reduced HRV is a marker for potential heart problems.

“Forty-five per cent of the 22 long-term survivors, whose median age is now 39, had diastolic dysfunction compared with 18% in 1997 and 27% had systolic dysfunction compared with 9% in 1997. The six patients with impaired systolic function also had abnormalities in the motion of the heart wall with suggestions of ischaemic heart disease in two of them. In addition, we knew that three of the nine patients who did not take part in this latest assessment, have or had cardiac dysfunction.”

She said that other studies involving moderate term follow-up of anthracyline-treated cancer survivors had produced conflicting results with some showing progressive abnormalities, while others showed no further deterioration. “We also found unchanged systolic function at our moderate term follow-up and now subsequently a further decrease, but our study, although small, has a 22-year median follow-up, which is considerably longer than most others, which have been about 13 years.”

“Our results suggest that after treatment with anthracyclines there is an ongoing deterioration of cardiac function and it is possible that this deterioration will continue, although we don’t know if and when there will be further progression. For this reason regular echocardiography seems important to monitor heart function. Most doxorubicin-treated survivors with cardiac abnormalities that show up on echocardiography have no cardiac complaints. We need to keep checking them and be ready to start medication to stabilise their heart function in order to prevent further cardiac deterioration and development of cardiac complaints. It is important to be ready to treat cardiovascular risk factors – for example, high blood pressure or cholesterol – and to encourage patients to make helpful lifestyle changes such as stopping smoking, reducing their weight if necessary and taking exercise.”

Dr Brouwer added that cardiotoxicity from anthracycline treatment is an issue in all cancer survivors that used this treatment, not just bone tumours. Although some studies have found younger people to be more at risk of heart damage, their study has not found young age was a factor. They are to continue their follow-up and expand their ongoing study to include all childhood cancer survivors treated at the University Medical Centre in Groningen.

But, she concluded by stressing that doxorubicin was a highly effective treatment and the cure of cancer was still the first priority. Patients now also tended to receive lower doses of doxorubicin although there were still some who needed high doses. If there is was a deterioration in heart function during treatment, doses were normally reduced. Furthermore, there were cardioprotective drugs, such as dexrazoxane available now, which were not available to earlier patients.

[1]Doxorubicin. Used to treat a wide range of cancers. It is one of a group of drugs known as anthracyclines. Anthracyclines act to prevent cell division by disrupting the structure of the DNA and terminate its function.

[2]Long-term cardiac follow-up in survivors of as malignant bone tumour. Annals of Oncology.doi:10.1093/annonc/mdl156.

Margaret Willson | alfa
Further information:
http://www.mwcommunications.org.uk

More articles from Studies and Analyses:

nachricht A sudden drop in outdoor temperature increases the risk of respiratory infections
11.01.2017 | University of Gothenburg

nachricht Urbanization to convert 300,000 km2 of prime croplands
27.12.2016 | Mercator Research Institute on Global Commons and Climate Change (MCC) gGmbH

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Interfacial Superconductivity: Magnetic and superconducting order revealed simultaneously

Researchers from the University of Hamburg in Germany, in collaboration with colleagues from the University of Aarhus in Denmark, have synthesized a new superconducting material by growing a few layers of an antiferromagnetic transition-metal chalcogenide on a bismuth-based topological insulator, both being non-superconducting materials.

While superconductivity and magnetism are generally believed to be mutually exclusive, surprisingly, in this new material, superconducting correlations...

Im Focus: Studying fundamental particles in materials

Laser-driving of semimetals allows creating novel quasiparticle states within condensed matter systems and switching between different states on ultrafast time scales

Studying properties of fundamental particles in condensed matter systems is a promising approach to quantum field theory. Quasiparticles offer the opportunity...

Im Focus: Designing Architecture with Solar Building Envelopes

Among the general public, solar thermal energy is currently associated with dark blue, rectangular collectors on building roofs. Technologies are needed for aesthetically high quality architecture which offer the architect more room for manoeuvre when it comes to low- and plus-energy buildings. With the “ArKol” project, researchers at Fraunhofer ISE together with partners are currently developing two façade collectors for solar thermal energy generation, which permit a high degree of design flexibility: a strip collector for opaque façade sections and a solar thermal blind for transparent sections. The current state of the two developments will be presented at the BAU 2017 trade fair.

As part of the “ArKol – development of architecturally highly integrated façade collectors with heat pipes” project, Fraunhofer ISE together with its partners...

Im Focus: How to inflate a hardened concrete shell with a weight of 80 t

At TU Wien, an alternative for resource intensive formwork for the construction of concrete domes was developed. It is now used in a test dome for the Austrian Federal Railways Infrastructure (ÖBB Infrastruktur).

Concrete shells are efficient structures, but not very resource efficient. The formwork for the construction of concrete domes alone requires a high amount of...

Im Focus: Bacterial Pac Man molecule snaps at sugar

Many pathogens use certain sugar compounds from their host to help conceal themselves against the immune system. Scientists at the University of Bonn have now, in cooperation with researchers at the University of York in the United Kingdom, analyzed the dynamics of a bacterial molecule that is involved in this process. They demonstrate that the protein grabs onto the sugar molecule with a Pac Man-like chewing motion and holds it until it can be used. Their results could help design therapeutics that could make the protein poorer at grabbing and holding and hence compromise the pathogen in the host. The study has now been published in “Biophysical Journal”.

The cells of the mouth, nose and intestinal mucosa produce large quantities of a chemical called sialic acid. Many bacteria possess a special transport system...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

12V, 48V, high-voltage – trends in E/E automotive architecture

10.01.2017 | Event News

2nd Conference on Non-Textual Information on 10 and 11 May 2017 in Hannover

09.01.2017 | Event News

Nothing will happen without batteries making it happen!

05.01.2017 | Event News

 
Latest News

Water - as the underlying driver of the Earth’s carbon cycle

17.01.2017 | Earth Sciences

Interfacial Superconductivity: Magnetic and superconducting order revealed simultaneously

17.01.2017 | Materials Sciences

Smart homes will “LISTEN” to your voice

17.01.2017 | Architecture and Construction

VideoLinks
B2B-VideoLinks
More VideoLinks >>>