Malignancy related cardiotoxicity

Cytotoxic drugs  Formation of free oxygen radicals  Induction of immunogenic reactions  Influence of the cytotoxic agent on certain phospholipids

Anthracyclines  Doxorubicin, epirubicin …  Cardiomyopathy, congestive heart failure  ECG alterations  Nonspecific ST-T changes, decreased QRS voltage, prolongation of QT interval

 Acute toxicity with anthracyclines  Rare, transient and during or immediately following infusion  Chronic effects  Decrease of LV function, changes in exercise-stress capacity and overt CHF  Can occur up to 20 years after completion of anthracycline therapy

 Risk factors  Cumulative dose, age, prior irradiation, concomitant administration of other chemotherapeutics and underlying heart disease  Monitoring  Echocardiography  Troponin T, BNP

Taxoids  Paclitaxel and docetaxel  Brady- and tachyarrhythmias, AV block, bundle branch blocks, cardiac ischemia and hypotension  Congestive heart failure  With a combination of doxorubicin

5-Fluorouracil  Myelosuppression, diarrhea, mucositis and dermatitis  Cardiotoxicity  Vary from 1% to 5% to as much as 18%  Usually with continuous infusion and less bolus injection  Cardiac arrhythmias, silent myocardial ischemia, angina, CHF and sudden death

Other agents  Cyclophosphamide, ifosfamide  Cisplatin  Trastuzumab  Monoclonal antibody against the HER2 receptor on breast ca.  Melphalan, fludarabin, mitomycin, busulfan…

Case report  An infant with CML at 2 months of age who was treated with increasing IFN-α for 7.5 months  Presented anorexia, general malaise, and nocturnal sewating for a week, followed by respiratory distress and tachycardia  Cardiomegaly and echographic changes of LV dilated cardiomyopathy, wih a 40% LVEF  Treated with digoxin, furosemide, and ACE inhibiotrs and IFN-α was discontinued

 Progressive improvement of cardiac function within 7 months fo the events with normalization of the echocardiographic findings with EF 60%

IFN-α  Anti-viral and anti-tumoral agent  Chronic hepatitis, melanoma, bladder ca, and CML  Cardiovascular effects  5% to 15%  CHF, supraventricular arrhythmias, acute coronary infarction  Unknown mechanism