PracticeUpdate: Haematology & Oncology

EDITOR’S PICKS 5

Introducing Editor’s Picks , a new section featuring the most recent top clinical trials in oncology and haematology specially selected by the PracticeUpdate Oncology Editorial and Advisory Board members.

Interventions for preventing cardiomyopathy due to anthracyclines By Reshma Mahtani, DO A nthracyclines are commonly used for the treatment of breast cancer. Dose-dependent risks of cardiotox-

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data are not an overwhelming endorsement of any specific approach. It is interesting to note that, despite the identification of risk factors, some patients with little exposure and no risk factors can develop considera- ble cardiac damage while others with higher exposure and risk factors do not develop any problems. This suggests a possible role of genetic susceptibility. A large number of polymorphisms have been reported in genes that mediate the metabolism, trans- port, and pharmacological activity of doxo- rubicin. The clinical significance of these findings is still under investigation, but may be the key to identifying patients at most risk. Once these patients are identified, the use of cardio-protectants such as ACE inhibitors, angiotensin-receptor blockers, and beta blockers may be used as part of an individualised plan for the prevention of anthracycline-induced cardiotoxicity.

icity and congestive heart failure are well- known. Risk factors for the development of cardiotoxicity have been investigated and include cumulative dose greater than >300 mg/m 2 ; age >65 years; history of hy- pertension, diabetes, or hyperlipidaemia; lifestyle factors such as smoking and obe- sity; history of prior radiation involving the chest; and the use of trastuzumab. Recent research has focused on early monitoring and risk stratification. The aim is to iden- tify patients at higher risk for the develop- ment of cardiotoxicity based on the use of biochemical markers and the prophylactic use of cardio-protectants. The current article is a systematic review of 16 randomised controlled trials evaluating the primary prevention of anthracycline-as- sociated toxicity with the use of various agents. The authors indicate that “moder- ate quality data suggest that dexrazoxane, and low quality data suggest angiotensin antagonists are likely to be effective for cardiotoxicity prevention.” The presented

The Rare Haematology Resource Centre is funded by Sanofi Genzyme and developed by Elsevier. Sanofi Genzyme has no editorial control over the content of the Resource Centre. All content therein has been subject to an independent editorial review.

Dr Mahtani is Assistant Clinical Professor of the Division of Hematology/ Oncology at the Sylvester Comprehensive Cancer Center, University of Maimi.

Sanofi Genzyme is the specialty care global business unit of Sanofi, focused on rare diseases, multiple sclerosis, oncology and immunology. 12–24 Talavera Road, Macquarie Park NSW 2113 Australia.

Interventions for preventing cardiomyopathy due to anthracyclines: a Bayesian Network meta-analysis Ann Oncol 2016 Dec 26;[EPub Ahead of Print], H Abdel-Qadir, G Ong, R Fazelzad, et al Take-home message • This systematic review used a Bayesian network meta-analysis to examine the effects of interventions to prevent cardiomyopathy in adult cancer patients treated with anthracyclines. A total of 16 randomised controlled trials including 1918 patients were identified for inclusion; these examined the use of dexrazoxane, beta blockers, angiotensin antagonists, beta blockers with angiotensin antagonists, prenylamine, N-acetylcysteine, coenzyme Q10, and statins. Only dexrazoxane treatment was demonstrably superior to placebo in reducing total cardiotoxicity events (pooled OR, 0.26), with 33% probability of being the most effective agent. When a single outlying study was removed, angiotensin antagonists had an 84% probability of being the most effective agent. When heart failure alone was considered, the dexrazoxane and angiotensin antagonists had odds ratios of 0.12 and 0.18, respectively. No evidence was found for increased risk of death or for effects on malignancy response rate with dexrazoxane or angiotensin antagonists. • This systematic review and meta-analysis found that dexrazoxane (based on moderate- quality data) and angiotensin antagonists (based on low-quality data) are potentially effective in preventing cardiotoxicity associated with anthracycline treatment.

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VOL. 2 • NO. 1 • 2017