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Abstract Objective: The objective of this study was to describe the clinical and imaging characteristics and the evolution of heart transplantation patients due to anthracycline-induced cardiomyopathy Methods: Patients with a diagnosis of ACM who received a heart transplantation in our institution in the period of November 2009-April 2021 were included. Clinical characteristics, pre-transplant studies, and clinical outcomes after transplantation were collected retrospectively from the electronic medical record. Results: A total of 11 patients were included in the study. The median age at the time of cancer diagnosis was 15 years (IQR 10-37 years), while the median age at the time of heart transplant was 56 years (IQR 39-62 years). Regarding post-transplant outcomes, three patients died in the post-operative period. One died 4 years after the intervention due to chronic rejection, while the other seven had a favorable evolution. No oncological relapse was observed with a median follow-up of 2.5 years (IQR 1.86-3.85 years). Conclusion: End-stage anthracycline-induced cardiomyopathy can occur many years after chemotherapy treatment, so close cardiovascular follow-up is extremely important. Heart transplantation is a treatment option after an exhaustive multidisciplinary evaluation, to minimize the risk of oncological relapse.
Resumen Objetivo: Describir las características clínicas, imagenológicas y la evolución de los pacientes trasplantados cardiacos por cardiotoxicidad inducida por antraciclinas. Métodos: Serie de casos descriptiva de pacientes consecutivos trasplantados cardiacos debido a cardiotoxicidad mediada por antraciclinas en el periodo de Noviembre de 2009 a Abril de 2021.Las características clínicas, los estudios complementarios pretrasplante y la información sobre la evolución posterior al trasplante fue recolectada de la historia clínica electrónica de forma retrospectiva. Resultados: Se incluyeron un total de 11 pacientes. La mediana de edad al diagnóstico de la patología oncológica fue de 15 años (RIC 10-37 años), mientras que la mediana de edad en la que recibieron el trasplante cardiaco fue de 56 años (RIC 39-62 años). Con respecto a la evolución posterior al trasplante, 3 pacientes murieron en el periodo del post operatorio inmediato. 1 paciente falleció a los 4 años del trasplante y los otros 7 pacientes tuvieron una evolución favorable. No se observó recaída oncológica en ningún paciente durante una mediana de seguimiento o de 2,5 años (RIC 1.86-3.85 años). Conclusión: La etapa final de la miocardiopatía inducida por antraciclinas puede ocurrir muchos años después del tratamiento con quimioterapia, por lo que es extremadamente importante un seguimiento cardiológico estricto. El trasplante cardiaco es una opción en este grupo de pacientes luego de una exhaustiva evaluación multidisciplinaria, con el fin de minimizar el riesgo de recaída oncológica.
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OBJECTIVE: The objective of this study was to describe the clinical and imaging characteristics and the evolution of heart transplantation patients due to anthracycline-induced cardiomyopathy. METHODS: Patients with a diagnosis of ACM who received a heart transplantation in our institution in the period of November 2009-April 2021 were included. Clinical characteristics, pre-transplant studies, and clinical outcomes after transplantation were collected retrospectively from the electronic medical record. RESULTS: A total of 11 patients were included in the study. The median age at the time of cancer diagnosis was 15 years (IQR 10-37 years), while the median age at the time of heart transplant was 56 years (IQR 39-62 years). Regarding post-transplant outcomes, three patients died in the post-operative period. One died 4 years after the intervention due to chronic rejection, while the other seven had a favorable evolution. No oncological relapse was observed with a median follow-up of 2.5 years (IQR 1.86-3.85 years). CONCLUSION: End-stage anthracycline-induced cardiomyopathy can occur many years after chemotherapy treatment, so close cardiovascular follow-up is extremely important. Heart transplantation is a treatment option after an exhaustive multidisciplinary evaluation, to minimize the risk of oncological relapse.
OBJETIVO: Describir las características clínicas, imagenológicas y la evolución de los pacientes trasplantados cardiacos por cardiotoxicidad inducida por antraciclinas. MÉTODOS: Serie de casos descriptiva de pacientes consecutivos trasplantados cardiacos debido a cardiotoxicidad mediada por antraciclinas en el periodo de Noviembre de 2009 a Abril de 2021.Las características clínicas, los estudios complementarios pretrasplante y la información sobre la evolución posterior al trasplante fue recolectada de la historia clínica electrónica de forma retrospectiva. RESULTADOS: Se incluyeron un total de 11 pacientes. La mediana de edad al diagnóstico de la patología oncológica fue de 15 años (RIC 10-37 años), mientras que la mediana de edad en la que recibieron el trasplante cardiaco fue de 56 años (RIC 39-62 años). Con respecto a la evolución posterior al trasplante, 3 pacientes murieron en el periodo del post operatorio inmediato. 1 paciente falleció a los 4 años del trasplante y los otros 7 pacientes tuvieron una evolución favorable. No se observó recaída oncológica en ningún paciente durante una mediana de seguimiento o de 2,5 años (RIC 1.86-3.85 años). CONCLUSIÓN: La etapa final de la miocardiopatía inducida por antraciclinas puede ocurrir muchos años después del tratamiento con quimioterapia, por lo que es extremadamente importante un seguimiento cardiológico estricto. El trasplante cardiaco es una opción en este grupo de pacientes luego de una exhaustiva evaluación multidisciplinaria, con el fin de minimizar el riesgo de recaída oncológica.
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Cardiomiopatias , Transplante de Coração , Humanos , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Antraciclinas/efeitos adversos , Estudos Retrospectivos , Cardiomiopatias/induzido quimicamente , RecidivaRESUMO
Although a growing body of evidence demonstrates that altered mtDNA content (mtDNAc) has clinical implications in several types of solid tumours, its prognostic relevance in acute promyelocytic leukaemia (APL) patients remains largely unknown. Here, we show that patients with higher-than-normal mtDNAc had better outcomes regardless of tumour burden. These results were more evident in patients with low-risk of relapse. The multivariate Cox proportional hazard model demonstrated that high mtDNAc was independently associated with a decreased cumulative incidence of relapse. Altogether, our data highlights the possible role of mitochondrial metabolism in APL patients treated with ATRA.
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Leucemia Promielocítica Aguda , Humanos , Leucemia Promielocítica Aguda/tratamento farmacológico , Leucemia Promielocítica Aguda/genética , Tretinoína/uso terapêutico , DNA Mitocondrial/genética , Relevância Clínica , Recidiva Local de Neoplasia/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Resultado do TratamentoRESUMO
Background: The aim of this study was to evaluate the association between well-defined genetic risk variants in SLC28A3, RARG and UGT1A6 and anthracycline-induced cardiotoxicity in Mexican pediatric patients. Methods: We tested a cohort of 79 children treated with anthracyclines for the presence of SLC28A3-rs7853758, RARG-rs2229774 and UGT1A6-rs17863783. Results: The SLC28A3-rs7853758 variant was more frequent in this cohort, while the UGT1A6-rs17863783 and RARG-rs2229774 variants were present at lower frequencies. A clinically important decrease of fractional shortening was associated with SLC28A3-rs7853758 variant. Conclusion: In this cohort, 39.2% of patients carried the protective SLC28A3 variant. A small number of tested patients have the risk variants of UGT1A6 and RARG. None of the patients shared the two risk variants.
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Antraciclinas , Cardiotoxicidade , Antraciclinas/efeitos adversos , Antibióticos Antineoplásicos , Cardiotoxicidade/genética , Criança , Humanos , Testes Farmacogenômicos , Fatores de RiscoRESUMO
BACKGROUND: The present retrospective study reviewed acute promyelocytic leukemia (APL) cases recorded in Mexico between January 2007 and January 2017. The primary objective of the study was to evaluate overall survival (OS) in Mexican patients with APL. Secondary objective was to evaluate the impact of induction treatment with different anthracyclines on OS, event-free survival (EFS) and complications in this patient population. METHODS: The medical charts of patients referred to medical institutions in Mexico from January 2007 through January 2017 for the treatment of suspected APL were reviewed retrospectively. Patients aged 15 - 75 years, in whom the diagnosis of APL was confirmed, who had an Eastern Cooperative Group performance status of 0 - 2, and who were eligible for combined treatment with intensive chemotherapy and all-trans retinoic acid (ATRA), were included in the study. Study participants received induction and consolidation treatment with ATRA plus either daunorubicin or idarubicin, followed by 2 years of single-agent ATRA as maintenance therapy. Patients who were unable to pay for ATRA treatment received anthracycline-based induction and consolidation, with methotrexate plus mercaptopurine as maintenance therapy. RESULTS: A total of 360 patients from 21 public and private hospitals were included in the study. The median age of the population was 37 years, and 51% were male. Of the 360 patients, 205 (57%) vs. 155 (43%) received daunorubicin vs. idarubicin as induction treatment for APL. ATRA was administered to 201 (98%) patients in the daunorubicin group vs. 138 (89%) in the idarubicin group (P = 0.001), and was initiated at diagnosis in 92% vs. 73% of recipients, respectively (P = 0.0001). At 150 months, OS and EFS for the entire population were 84% and 79%, respectively. Both OS (90% vs. 76%, P = 0.003) and EFS (85% vs. 72%, P = 0.001) were significantly prolonged in daunorubicin vs. idarubicin recipients. Rates of complications were similar in the two groups. CONCLUSIONS: As arsenic trioxide (ATO) is not currently available in Mexico, anthracycline plus ATRA is the mainstay of treatment for APL here. Our results confirm the efficacy of this strategy, with high OS and EFS rates being observed 12.5 years after diagnosis.
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INTRODUCTION: One of the most used regimens to treat breast cancer is the dose-dense ACT protocol, a combination of anthracycline doxorubicin (DOX) with cyclophosphamide and paclitaxel (PCTX). However, many tumors show resistance to the protocols applied. It is known that the nucleotide excision repair (NER) pathway acts by removing the DOX-generated lesions, and this, together with other DNA repair pathways, can modulate the response to treatment. AIMS: To evaluate the in vitro growth profile of breast cancer cells (MCF7), and the modulation of DNA repair genes, submitted to a protocol using DOX and PCTX in a similar regimen to what is used in clinical practice. MAIN METHODS: MCF7 cells were treated with repeated cycles of DOX and PCTX and followed-up during and after each of the treatments. The population doubling of the remaining cells was calculated during the complete protocol and DNA repair gene expression was evaluated at different time-points. KEY FINDINGS: An increase in all NER genes analyzed after the DOX treatment was observed, but not after the PCTX treatment. MRE11was overexpressed at all evaluated time-points. There was a resumption of NER genes overexpression profile when cells were maintained for follow-up and retook their growth pattern, indicating that DNA repair pathways can modulate their expression during the chemotherapy exposure.
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Protocolos de Quimioterapia Combinada Antineoplásica/farmacologia , Neoplasias da Mama/tratamento farmacológico , Reparo do DNA/efeitos dos fármacos , Neoplasias da Mama/genética , Neoplasias da Mama/patologia , Proliferação de Células/efeitos dos fármacos , Doxorrubicina/administração & dosagem , Doxorrubicina/farmacologia , Feminino , Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Humanos , Células MCF-7 , Paclitaxel/administração & dosagemRESUMO
BACKGROUND: Cardiotoxicity is a common and serious adverse effect of anthracycline therapy in breast cancer patients. The current criteria for cardiotoxicity are based on imaging and cardiac biomarkers. However, there is a need for new biomarkers to help with early diagnosis. MicroRNAs (miRNAs) are small non-coding RNA molecules that play an important role in the regulation of gene expression. Several miRNAs have been associated with cardiovascular diseases and are biomarkers under investigation for cancer treatment-related cardiotoxicity. METHODS: We performed a systematic literature search of Medline/PubMed, Cochrane Central Register of Controlled Trials, Scopus, Lilacs, Web of Science and Embase, until April 2020. Cohort studies that reported miRNA biomarkers in breast cancer patients with anthracycline-induced cardiotoxicity and non-cardiotoxicity patients were included. Moreover, we searched the miRTarBase for experimentally validated miRNA-target interactions. RESULTS: Among the 209 studies retrieved, five fulfilled the inclusion criteria. Let-7f, miR-1, miR-20a, miR-126 and miR-210 were validated in two population-based cohorts. The pro-angiogenic miRNAs let-7f, miR-20a, miR-126 and miR-210 were significantly down-regulated in epirubicin-cardiotoxicity when compared to the non-cardiotoxicity group. miR-1 has been shown to provide diagnostic and prognostic information in the setting of myocardial infarction, but changes in its levels are controversial in doxorubicin-treated breast cancer patients with cardiotoxicity. Reactome pathways relevant to cardiotoxicity were found from the target genes for let-7f, miR-1, miR-20a, miR-126 and miR-210 at miRTarBase. CONCLUSION: The data suggest that let-7f, miR-1, miR-20a, miR-126 and miR-210 are associated with anthracycline-based cardiotoxicity during chemotherapy in breast cancer patients.
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Antraciclinas/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Cardiotoxicidade/etiologia , MicroRNAs/fisiologia , Neoplasias da Mama/genética , Feminino , Humanos , MicroRNAs/sangueRESUMO
OBJECTIVES: The authors performed a systematic review and meta-analysis of randomized and nonrandomized trials on the efficacy of dexrazoxane in patients with breast cancer who were treated with anthracyclines with or without trastuzumab. BACKGROUND: Breast cancer treatment with anthracyclines and trastuzumab is associated with an increased risk of cardiotoxicity. Among the various strategies to reduce the risk of cardiotoxicity, dexrazoxane is an option for primary prevention, but it is seldom used in clinical practice. METHODS: Online databases were searched from January 1990 up to March 1, 2019, for clinical trials on the use of dexrazoxane for the prevention of cardiotoxicity in patients with breast cancer receiving anthracyclines with or without trastuzumab. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model meta-analysis. RESULTS: Seven randomized trials and 2 retrospective trials with a total of 2,177 patients were included. Dexrazoxane reduced the risk of clinical heart failure (RR: 0.19; 95% CI: 0.09 to 0.40; p < 0.001) and cardiac events (RR: 0.36; 95% CI: 0.27 to 0.49; p < 0.001) irrespective of previous exposure to anthracyclines. The rate of a partial or complete oncological response, overall survival, and progression-free survival were not affected by dexrazoxane. CONCLUSIONS: Dexrazoxane reduced the risk of clinical heart failure and cardiac events in patients with breast cancer undergoing anthracycline chemotherapy with or without trastuzumab and did not significantly impact cancer outcomes. However, the quality of available evidence is low, and further randomized trials are warranted before the systematic implementation of this therapy in clinical practice.
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BACKGROUND: Extranodal NK/T-cell lymphoma, nasal type (ENKTCL) has a high prevalence in Asia and Latin American countries, such as Mexico, where it encompasses 40% of all T-cell non-Hodgkin lymphomas. Historically, responses to anthracycline-based therapies have been disappointing. Since data about the effectiveness of L-asparaginase-based regimens in Mexico are limited, we compared both therapies in our center. METHODS: We performed a retrospective cohort of patients with newly diagnosed ENKTCL, who were divided into two groups for treatment and analysis (group 1: L-asparaginase-based regimen and group 2: anthracycline-based regimen) between 2001 and 2016. RESULTS: Of 36 patients with newly-diagnosed ENKTCL, 33 received at least one cycle of chemotherapy (22 in group 1 and 11 in group 2). Over a median follow-up interval of 17 months (range, 0-167), a complete response (CR) was observed in 45.5% of patients in group 1, compared to 27% of group 2 (P=0.45). Progression was more frequently observed in group 2 than in group 1 (54.5% vs. 18.4%, P=0.04). The median overall survival (OS) was 44 months in group 1, compared to 5 months in group 2 (P=0.012). The multivariate analysis showed that failure to achieve a CR after first-line therapy was the only significant factor for OS (HR, 3.04; 95% CI, 1.4-6.5; P=0.005). CONCLUSION: L-asparaginase-based regimens for patients with newly-diagnosed ENKTCL confer a survival advantage over anthracycline-based regimens.
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This study evaluated the activity of the ethanolic extract of pequi peel (EEPP) and immunostaining with matrix metalloproteinases 2 and 9 (MMP2 and MMP9), and tissue inhibitor of metalloproteinases 1 and 2 (TIMP1 and TIMP2) in the myocardium of rats subjected to acute cardiotoxicity using doxorubicin (DOX). Thirty Wistar rats (six groups of five animals) were used as follows: sham group (SG), water and saline; group G1, 16 mg/kg of DOX and 300 mg/kg of EEPP for 17 days; group G2, 16 mg/kg of DOX and 600 mg/kg of EEPP for 17 days; group G3, 16 mg/kg of DOX and 300 mg/kg of EEPP for 10 days; group G4, 16 mg/kg of DOX and 600 mg/kg of EEPP for 10 days; and control group (CG), 16 mg/kg of DOX. Three days after administering DOX (day 17), euthanasia was performed, and samples were collected for anatomopathological analysis. Myocyte vacuolar degeneration, cardiomyocyte disorganization and myofibrillar fragmentation, necrosis, mononuclear inflammatory infiltrate, Anitschkow cells, fibrosis, congestion, and edema were observed in the hearts of DOX recipients. In G1 and G2, EEPP attenuated myocyte vacuolar degeneration whereas in G4, EEPP attenuated cardiomyocyte disorganization. The percentage of cells immunoreactive for TIMP1 was higher in G1. It was concluded that EEPP minimizes the deleterious effects of DOX on rat myocardium. Doses of 300 and 600 mg/kg for 17 days attenuate the vacuolar degeneration of myocytes. The dose of 600 mg/kg for 10 days reduced cardiomyocyte disorganization, and the dose of 300 mg/kg for 17 days increased TIMP1 expression in the myocardium of DOX-treated rats.(AU)
Avaliou-se a ação do extrato etanólico da casca do pequi (EECP) e a imunomarcação de metaloproteinases de matriz 2 e 9 (MMP2 e MMP9), e inibidores teciduais das metaloproteinases de matriz 1 e 2 (TIMP1 e TIMP2), no miocárdio de ratos submetidos à cardiotoxicidade aguda pela doxorrubicina (DOX). Utilizaram-se 30 ratos Wistar, em seis grupos de cinco animais, sendo Grupo Sham (GS) água e salina; (G1) 16 mg/kg de DOX e 300 mg/kg de EECP por 17 dias; (G2) 16 mg/kg de DOX e 600 mg/kg de EECP por 17 dias; (G3) 16 mg/kg de DOX e 300 mg/kg de EECP por 10 dias; (G4) 16 mg/kg de DOX e 600 mg/kg de EECP por 10 dias; e grupo controle (GC) 16 mg/kg de DOX. Três dias após a aplicação da DOX, no dia 17, realizaram-se a eutanásia e colheita de amostras para análises antomopatológicas. No coração dos ratos que receberam DOX observaram-se degeneração vacuolar miocítica, desorganização dos cardiomiócitos e fragmentação das miofibrilas, necrose, infiltrado inflamatório mononuclear, células de Anitschkow, fibrose, congestão e edema. Nos grupos G1 e G2 o EECP atenuou a degeneração vacuolar miocítica e no G4 atenuou a desorganização dos cardiomiócitos. TIMP1 foi constatada em maior porcentagem de células marcadas no grupo de ratos que recebeu 300 mg/kg do EECP por 17 dias. Conclui-se que o EECP minimiza os efeitos deletérios da DOX no miocárdio de ratos. Nas doses de 300 e 600 mg/kg por 17 dias atenua a degeneração vacuolar miocítica, a 600 mg/kg por 10 dias reduz a desorganização dos cardiomiócitos e a 300 mg/kg por 17 dias aumenta a expressão de TIMP1 no miocárdio de ratos tratados com DOX.(AU)
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Animais , Cobaias , Cardiotoxicidade/tratamento farmacológico , Fitoterapia , Ericales , Ratos Wistar , Metaloproteases , Antineoplásicos/toxicidade , Preparações de Plantas/uso terapêuticoRESUMO
OBJECTIVES: The goal of this study was to demonstrate that cardiac magnetic resonance could reveal anthracycline-induced early tissue remodeling and its relation to cardiac dysfunction and left ventricular (LV) atrophy. BACKGROUND: Serum biomarkers of cardiac dysfunction, although elevated after chemotherapy, lack specificity for the mechanism of myocardial tissue alterations. METHODS: A total of 27 women with breast cancer (mean age 51.8 ± 8.9 years, mean body mass index 26.9 ± 3.6 kg/m2), underwent cardiac magnetic resonance before and up to 3 times after anthracycline therapy. Cardiac magnetic resonance variables were LV ejection fraction, normalized T2-weighted signal intensity for myocardial edema, extracellular volume (ECV), LV cardiomyocyte mass, intracellular water lifetime (τic; a marker of cardiomyocyte size), and late gadolinium enhancement. RESULTS: At baseline, patients had a relatively low (10-year) Framingham cardiovascular event risk (median 5%), normal LV ejection fractions (mean 69.4 ± 3.6%), and normal LV mass index (51.4 ± 8.0 g/m2), a mean ECV of 0.32 ± 0.038, mean τic of 169 ± 69 ms, and no late gadolinium enhancement. At 351 to 700 days after anthracycline therapy (240 mg/m2), mean LV ejection fraction had declined by 12% to 58 ± 6% (p < 0.001) and mean LV mass index by 19 g/m2 to 36 ± 6 g/m2 (p < 0.001), and mean ECV had increased by 0.037 to 0.36 ± 0.04 (p = 0.004), while mean τic had decreased by 62 ms to 119 ± 54 ms (p = 0.004). Myocardial edema peaked at about 146 to 231 days (p < 0.001). LV mass index was associated with τic (ß = 4.1 ± 1.5 g/m2 per 100-ms increase in τic, p = 0.007) but not with ECV. Cardiac troponin T (mean 4.6 ± 1.4 pg/ml at baseline) increased significantly after anthracycline treatment (p < 0.001). Total LV cardiomyocyte mass, estimated as: (1 - ECV) × LV mass, declined more rapidly after anthracycline therapy, with peak cardiac troponin T >10 pg/ml. There was no evidence for any significant interaction between 10-year cardiovascular event risk and the effect of anthracycline therapy. CONCLUSIONS: A decrease in LV mass after anthracycline therapy may result from cardiomyocyte atrophy, demonstrating that mechanisms other than interstitial fibrosis and edema can raise ECV. The loss of LV cardiomyocyte mass increased with the degree of cardiomyocyte injury, assessed by peak cardiac troponin T after anthracycline treatment. (Doxorubicin-Associated Cardiac Remodeling Followed by CMR in Breast Cancer Patients; NCT03000036).
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Antibióticos Antineoplásicos/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Doxorrubicina/efeitos adversos , Imagem Cinética por Ressonância Magnética , Miócitos Cardíacos/patologia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Adulto , Atrofia , Biomarcadores/sangue , Cardiotoxicidade , Meios de Contraste/administração & dosagem , Feminino , Humanos , Meglumina/administração & dosagem , Pessoa de Meia-Idade , Miócitos Cardíacos/efeitos dos fármacos , Miócitos Cardíacos/metabolismo , Compostos Organometálicos/administração & dosagem , Valor Preditivo dos Testes , Fatores de Risco , Fatores de Tempo , Troponina T/sangue , Disfunção Ventricular Esquerda/induzido quimicamente , Disfunção Ventricular Esquerda/patologia , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda/efeitos dos fármacos , Remodelação Ventricular/efeitos dos fármacosRESUMO
This study evaluated the activity of the ethanolic extract of pequi peel (EEPP) and immunostaining with matrix metalloproteinases 2 and 9 (MMP2 and MMP9), and tissue inhibitor of metalloproteinases 1 and 2 (TIMP1 and TIMP2) in the myocardium of rats subjected to acute cardiotoxicity using doxorubicin (DOX). Thirty Wistar rats (six groups of five animals) were used as follows: sham group (SG), water and saline; group G1, 16 mg/kg of DOX and 300 mg/kg of EEPP for 17 days; group G2, 16 mg/kg of DOX and 600 mg/kg of EEPP for 17 days; group G3, 16 mg/kg of DOX and 300 mg/kg of EEPP for 10 days; group G4, 16 mg/kg of DOX and 600 mg/kg of EEPP for 10 days; and control group (CG), 16 mg/kg of DOX. Three days after administering DOX (day 17), euthanasia was performed, and samples were collected for anatomopathological analysis. Myocyte vacuolar degeneration, cardiomyocyte disorganization and myofibrillar fragmentation, necrosis, mononuclear inflammatory infiltrate, Anitschkow cells, fibrosis, congestion, and edema were observed in the hearts of DOX recipients. In G1 and G2, EEPP attenuated myocyte vacuolar degeneration whereas in G4, EEPP attenuated cardiomyocyte disorganization. The percentage of cells immunoreactive for TIMP1 was higher in G1. It was concluded that EEPP minimizes the deleterious effects of DOX on rat myocardium. Doses of 300 and 600 mg/kg for 17 days attenuate the vacuolar degeneration of myocytes. The dose of 600 mg/kg for 10 days reduced cardiomyocyte disorganization, and the dose of 300 mg/kg for 17 days increased TIMP1 expression in the myocardium of DOX-treated rats.
Avaliou-se a ação do extrato etanólico da casca do pequi (EECP) e a imunomarcação de metaloproteinases de matriz 2 e 9 (MMP2 e MMP9), e inibidores teciduais das metaloproteinases de matriz 1 e 2 (TIMP1 e TIMP2), no miocárdio de ratos submetidos à cardiotoxicidade aguda pela doxorrubicina (DOX). Utilizaram-se 30 ratos Wistar, em seis grupos de cinco animais, sendo Grupo Sham (GS) água e salina; (G1) 16 mg/kg de DOX e 300 mg/kg de EECP por 17 dias; (G2) 16 mg/kg de DOX e 600 mg/kg de EECP por 17 dias; (G3) 16 mg/kg de DOX e 300 mg/kg de EECP por 10 dias; (G4) 16 mg/kg de DOX e 600 mg/kg de EECP por 10 dias; e grupo controle (GC) 16 mg/kg de DOX. Três dias após a aplicação da DOX, no dia 17, realizaram-se a eutanásia e colheita de amostras para análises antomopatológicas. No coração dos ratos que receberam DOX observaram-se degeneração vacuolar miocítica, desorganização dos cardiomiócitos e fragmentação das miofibrilas, necrose, infiltrado inflamatório mononuclear, células de Anitschkow, fibrose, congestão e edema. Nos grupos G1 e G2 o EECP atenuou a degeneração vacuolar miocítica e no G4 atenuou a desorganização dos cardiomiócitos. TIMP1 foi constatada em maior porcentagem de células marcadas no grupo de ratos que recebeu 300 mg/kg do EECP por 17 dias. Conclui-se que o EECP minimiza os efeitos deletérios da DOX no miocárdio de ratos. Nas doses de 300 e 600 mg/kg por 17 dias atenua a degeneração vacuolar miocítica, a 600 mg/kg por 10 dias reduz a desorganização dos cardiomiócitos e a 300 mg/kg por 17 dias aumenta a expressão de TIMP1 no miocárdio de ratos tratados com DOX.
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Animais , Cobaias , Cardiotoxicidade/tratamento farmacológico , Ericales , Fitoterapia , Antineoplásicos/toxicidade , Metaloproteases , Preparações de Plantas/uso terapêutico , Ratos WistarRESUMO
PURPOSE: The goal of this study was to evaluate late cardiotoxic effects of anthracyclines (ATC) by evaluating cardiac sympathetic activity in a cohort of asymptomatic patients previously treated with ATC for childhood cancers. METHODS: We studied 89 asymptomatic patients previously treated with ATC with a normal echocardiogram (49 men and 40 women) and a control group of 40 healthy individuals (26 men and 14 women). Both groups underwent planar myocardial 123I-meta-iodobenzylguanidine scintigraphy (123I-mIBG). From these images, the early and late heart-to-mediastinum (H/M) ratio and washout rate (WR) were assessed. RESULTS: The mean survival at the time of the 123I-mIBG scintigraphy was 5.3 ± 3.4 years. Patients treated with ATC had a lower but clinical normal left ventricular ejection fraction (LVEF) compared to controls (60.44 ± 6.5 vs 64.1 ± 6.0%, P < 0.01). Both the late H/M ratio and WR were not able to discriminate ATC treated patients from controls. The cumulative ATC dose was the only independent predictor of the LVEF, explaining approximately 12% of the variation in LVEF (P = 0.01). CONCLUSIONS: Although the pathophysiology behind ATC cardiotoxicity is most likely multifactorial, myocardial sympathetic activity is not associated with a reduction in LVEF 5-years after completion of chemotherapy.
Assuntos
Antraciclinas/uso terapêutico , Doenças do Sistema Nervoso Autônomo/diagnóstico por imagem , Doenças do Sistema Nervoso Autônomo/mortalidade , Neoplasias/tratamento farmacológico , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/mortalidade , 3-Iodobenzilguanidina , Adolescente , Adulto , Antineoplásicos/efeitos adversos , Brasil/epidemiologia , Cardiotoxicidade/diagnóstico por imagem , Cardiotoxicidade/mortalidade , Causalidade , Criança , Pré-Escolar , Comorbidade , Feminino , Humanos , Masculino , Neoplasias/mortalidade , Prevalência , Compostos Radiofarmacêuticos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Taxa de Sobrevida , Resultado do TratamentoRESUMO
PURPOSE: While much progress has been made in the treatment of breast cancer, cardiac complications resulting from therapy remain a significant concern. Both anthracyclines and novel targeted agents can inflict cardiac damage. The present study aimed to evaluate the difference between what it is currently done and what standards of care should be used to minimizing and managing cardiac toxicity in breast cancer survivors. METHODS: A two-round multicenter Delphi study was carried out. The panel consisted of 100 oncologists who were asked to define the elected therapies for breast cancer patients, the clinical definition and patterns of cancer drug-derived cardiac toxicity, and those protocols focused on early detection and monitoring of cardiovascular outcomes. RESULTS: Experts agreed a more recent definition of cardiotoxicity. Around 38 % of patients with early-stage disease, and 51.3 % cases with advanced metastatic breast cancer had preexisting risk factors for cardiotoxicity. Among risk factors, cumulative dose of anthracycline ≥450 mg/m2 and its combination with other anticancer drugs, and a preexisting cardiovascular disease were considered the best predictors of cardiotoxicity. Echocardiography and radionuclide ventriculography have been the proposed methods for monitoring changes in cardiac structure and function. Breast cancer is generally treated with anthracyclines (80 %), so that the panel strongly stated about the need to plan a strategy to managing cardiotoxicity. A decline of left ventricular ejection fraction (LVEF) >10 %, to an LVEF value <53 % was suggested as a criterion for changing the dose schedule of anthracyclines, or suspending the treatment of chemotherapy plus trastuzumab until the normalization of the left ventricular function. The use of liposomal anthracyclines was strongly suggested as a treatment option for breast cancer patients. CONCLUSIONS: The present report is the first to produce a set of statements on the prevention, evaluation and monitoring of chemotherapy-induced cardiac toxicity in breast cancer patients.
Assuntos
Antraciclinas/efeitos adversos , Antineoplásicos/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Cardiotoxicidade/etiologia , Cardiotoxicidade/prevenção & controle , Técnica Delphi , Função Ventricular Esquerda/efeitos dos fármacos , Idoso , Feminino , Seguimentos , Humanos , Estadiamento de Neoplasias , Prognóstico , Fatores de RiscoRESUMO
BACKGROUND: Anthracyclines are effective drugs in pediatrics cancer treatment. However, anthracycline-induced cardiotoxicity (AIC) is a serious adverse drug reaction that affects the survival in patients treated for childhood cancer. CLINICAL CASES: Case 1: Nine-year-old girl with stage IV Hodgkin lymphoma with 12 epirubicin doses and a cumulative dose of 576 mg/m2. After last chemotherapy dose, the patient was admitted with systemic inflammatory response, asthenia and adinamia. Echocardiography: LVEF of 22%, SF 11% and moderate mitral regurgitation. Patient died 2 days after diagnosed with dilated cardiomyopathy secondary to anthracyclines. Case 2: Fifteen-year-old girl with stage IV Burkitt lymphoma with two epirubicin doses and a cumulative dose of 90 mg/m2. After the last cycle, the patient developed several infectious foci. Echocardiography: LVEF of 49%, SF 20% and dilated left ventricle with septal flattening. Patient died 13 days after diagnosis of dilated cardiomyopathy by anthracyclines. CONCLUSION: AIC is a problem in pediatric patients receiving anthracyclines, monitoring is essential to detect the onset of cardiac damage to provide an intervention to prevent heart failure progress.
Introducción: las antraciclinas son fármacos eficaces en el tratamiento de pacientes pediátricos con cáncer. Sin embargo, la cardiotoxicidad inducida por antraciclinas (CIA) es una reacción adversa grave que afecta la sobrevida de niños y jóvenes. Casos clínicos: el caso 1 estuvo constituido por una paciente de nueve años con linfoma de Hodgkin estadio IV con 12 ciclos de quimioterapia con epirrubicina y una dosis acumulada de 576 mg/m2. Después del último ciclo de quimioterapia, la paciente ingresó con respuesta inflamatoria sistémica, astenia y adinamia. El ecocardiograma reportó una FEVI de 22 %, FA de 11 % e insuficiencia mitral moderada. La paciente falleció dos días después con diagnóstico de cardiomiopatía dilatada secundaria a antraciclinas. El caso 2 fue el de una paciente de 15 años con linfoma no Hodgkin tipo Burkitt estadio IV, con dos ciclos de quimioterapia con epirrubicina y una dosis acumulada de 90 mg/m2. Después del último ciclo, la paciente presentó diversos focos infecciosos. El ecocardiograma reportó una FEVI de 49 %, una FA de 20 % y dilatación del ventrículo izquierdo con aplanamiento septal. La paciente falleció 13 días después del diagnóstico de cardiomiopatía dilatada por antraciclinas. Conclusión: la CIA es un problema en los pacientes pediátricos que reciben antraciclinas. El monitoreo durante y después de la quimioterapia es indispensable para detectar el inicio del daño cardiaco a fin de brindar una intervención oportuna que evite la evolución a una insuficiencia cardiaca.
Assuntos
Antibióticos Antineoplásicos/efeitos adversos , Cardiomiopatia Dilatada/induzido quimicamente , Epirubicina/efeitos adversos , Adolescente , Cardiomiopatia Dilatada/diagnóstico , Cardiotoxicidade , Criança , Evolução Fatal , Feminino , HumanosRESUMO
Anthracyclines are cytostatic antibiotics discovered almost half a century ago exerting their action through inhibition of topoisomerase II. The two most representative drugs are doxorubicin and daunorubicin and they have been proven as useful antineoplastics and are widely prescribed in daily oncology practice; unfortunately, cardiotoxicity has been a limiting factor when it comes to their use. Diverse mechanisms have been involved in anthracycline cardiotoxicity, none of which are capable of causing the whole clinical picture by itself. Traditionally, reactive oxygen species (ROS) have received more attention, although recently basic research has proven other factors to be as important as ROS. These factors mainly involve sarcomeric structure disruption, toxic accumulation of metabolites, iron metabolism, energetic alterations and inflammation. The role of genetics has been studied by some groups, although a clear genotype-response relationship is yet to be elucidated. With the improved survival from different oncologic diseases we are witnessing more cases of chemotherapy-induced cardiotoxicity and the advent of new anticancer drugs poses several challenges for the cardiologist, highlighting the importance of a deep knowledge of the main mechanisms inducing this toxicity.
Hace casi medio siglo se descubrieron las antraciclinas; estas son antibióticos citostáticos inhibidores de la topoisomerasa II. Los 2 fármacos más representativos de este grupo son la doxorrubicina y la daunorrubicina. Estos fármacos han demostrado ser eficaces antineoplásicos y han sido ampliamente utilizados en la práctica oncológica. Desafortunadamente, la cardiotoxicidad sigue siendo un elemento limitante para su uso. Los mecanismos mediante los cuales estos fármacos ocasionan cardiotoxicidad son múltiples pero ninguno de ellos de forma individual es capaz de explicar el cuadro clínico por completo. Casi siempre se ha considerado que la formación de especies reactivas de oxígeno era responsable de gran parte de la toxicidad, sin embargo la experimentación básica reciente ha demostrado que hay otros factores, entre los que destacan las alteraciones en la estructura sarcomérica, la acumulación de metabolitos tóxicos, las alteraciones del metabolismo del hierro o de los mecanismos energéticos, y la liberación de mediadores de inflamación. Por otra parte, diversos grupos han investigado la intervención que la genética podría tener en el desarrollo de esta enfermedad, si bien no se puede definir aún una clara correlación genotipo-respuesta. Con el aumento de la supervivencia por el tratamiento de diversas enfermedades oncológicas, se están detectando más casos de cardiotoxicidad mediada por quimioterapia; y con la aparición de nuevos fármacos quimioterápicos se añaden nuevos retos, con lo que se demuestra la importancia del estudio profundo de los mecanismos causales.
Assuntos
Humanos , Antraciclinas/efeitos adversos , Cardiomiopatias/induzido quimicamente , Antraciclinas/metabolismo , CardiologiaRESUMO
Anthracyclines are cytostatic antibiotics discovered almost half a century ago exerting their action through inhibition of topoisomerase II. The two most representative drugs are doxorubicin and daunorubicin and they have been proven as useful antineoplastics and are widely prescribed in daily oncology practice; unfortunately, cardiotoxicity has been a limiting factor when it comes to their use. Diverse mechanisms have been involved in anthracycline cardiotoxicity, none of which are capable of causing the whole clinical picture by itself. Traditionally, reactive oxygen species (ROS) have received more attention, although recently basic research has proven other factors to be as important as ROS. These factors mainly involve sarcomeric structure disruption, toxic accumulation of metabolites, iron metabolism, energetic alterations and inflammation. The role of genetics has been studied by some groups, although a clear genotype-response relationship is yet to be elucidated. With the improved survival from different oncologic diseases we are witnessing more cases of chemotherapy-induced cardiotoxicity and the advent of new anticancer drugs poses several challenges for the cardiologist, highlighting the importance of a deep knowledge of the main mechanisms inducing this toxicity.
Assuntos
Antraciclinas/efeitos adversos , Cardiomiopatias/induzido quimicamente , Antraciclinas/metabolismo , Cardiologia , HumanosAssuntos
Antineoplásicos/efeitos adversos , Terapia por Exercício , Cardiopatias/induzido quimicamente , Cardiopatias/prevenção & controle , Substâncias Protetoras/uso terapêutico , Animais , Citoproteção , Cardiopatias/metabolismo , Humanos , Terapia de Alvo Molecular , Miocárdio/metabolismo , Medição de Risco , Fatores de Risco , Transdução de Sinais/efeitos dos fármacos , Resultado do TratamentoRESUMO
Although breast cancer is, unfortunately, not uncommon in women, a mere 0.04% of malignant breast tumours are primary angiosarcomas. Chemotherapy is advocated for treatment of breast angiosarcomas; however, no guidelines exist regarding optimal chemotherapeutics or protocols. Presently, the prognosis for breast angiosarcomas is poor. This case report describes a 24-year old woman diagnosed with primary breast angiosarcoma. She initially refused to receive treatment, but later returned to the hospital four years later with a haemopneumothorax. She was treated with rescue chemotherapy using a combination of high-dose tamoxifen plus ifosfamide and epirubicin (an anthracycline). She achieved a partial response, but died 16 months after therapy was initiated. More research is needed to devise novel chemotherapeutics and protocols to improve outcomes in women diagnosed with primary angiosarcomas ofthe breast.
Aunque el cáncer de mama, desafortunadamente, no es poco común en las mujeres, apenas 0.04% de los tumores malignos de mama son angiosarcomas primarios. La quimioterapia es el tratamiento de preferencia en los casos de angiosarcomas de mama. Sin embargo, no existen guías en relación con los protocolos o la quimioterapia óptima. En la actualidad, el pronóstico para los angiosarcomas de mama es pobre. Este informe del caso describe a una mujer de 24 años diagnosticada con angiosarcoma primario de mama. Inicialmente la paciente se negó a recibir tratamiento, pero volvió al hospital cuatro años más tarde con un hemoneumotórax. Fue tratada entonces con quimioterapia de rescate usando una combinación de alta dosis de tamoxifen con ifosfamida y epirrubicina (antraciclina). Llegó a responder parcialmente al tratamiento, pero falleció 16 meses después del inicio de la terapia. Se necesitan más investigaciones para elaborar nuevos quimioterápeuticos y protocolos que mejoren los resultados en los casos de mujeres diagnosticadas con angiosarcomas primarios de mama.
Assuntos
Humanos , Feminino , Adulto Jovem , Neoplasias da Mama/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Hemangiossarcoma/tratamento farmacológico , Tamoxifeno/administração & dosagem , Evolução Fatal , Antraciclinas/administração & dosagem , Ifosfamida/administração & dosagemRESUMO
La leucemia mieloide aguda abarca un heterógeneo espectro de enfermedades, de naturaleza maligna y clonal, que representan un reto formidable para la medicina moderna. Con la excepción de la leucemia promielocítica, los resultados terapéuticos alcanzados continúan siendo desalentadores. Recientemente han surgido datos que demuestran mejores resultados con el uso de altas dosis de antraciclinas en la inducción. Se presentó el primer caso en Cuba, en cuya inducción se utilizó la rubidomicina a 100 mg/m² por 3 d, más el arabinósido de citosina a 100 mg/m² por 7 d, ambos en infusión endovenosa continua. La evolución clínica es satisfactoria hasta el momento. Se revisó brevemente la literatura médica al respecto...
The acute myeloid leukemia includes an heterogeneous spectrum of diseases of malignant and clonal origin representing a challenge of the current medicine. With the exception of the pro-myelocytic, the achieved therapeutical results continue being discouraging. Recently are available data demonstrating better results with the use of high doses of anthracycline in the induction. This is the first case in Cuba where in induction it was used the 100 mg/m² rubidomicin plus 100 mg/m2 for three days plus 100 mg/m² arabinoside for seven days, both in continuous intravenous infusion. The clinical course is satisfactory until now. Authors made a brief review of medical literature in this respect...