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Managing Chemotherapy-Related Cardiotoxicity in Survivors of Childhood Cancers

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Abstract

In the US, children diagnosed with cancer are living longer, but not without consequences from the same drugs that cured their cancer. In these patients, cardiovascular disease is the leading cause of non-cancer-related morbidity and mortality. Although this review focuses on anthracycline-related cardiomyopathy in childhood cancer survivors, the global lifetime risk of other cardiovascular diseases such as atherosclerosis, arrhythmias and intracardiac conduction abnormalities, hypertension, and stroke also are increased. Besides anthracyclines, newer molecularly targeted agents, such as vascular endothelial growth factor receptor and tyrosine kinase inhibitors, also have been associated with acute hypertension, cardiomyopathy, and increased risk of ischemic cardiac events and arrhythmias, and are summarized here. This review also covers other risk factors for chemotherapy-related cardiotoxicity (including both modifiable and non-modifiable factors), monitoring strategies (including both blood and imaging-based biomarkers) during and following cancer treatment, and discusses the management of cardiotoxicity (including prevention strategies such as cardioprotection by use of dexrazoxane).

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Acknowledgements

The authors have no conflicts of interest that are directly relevant to the content of this review. Eric Chow is supported by grants from the National Cancer Institute (K07 CA151775), the Leukemia and Lymphoma Society, and the St. Baldricks’ Foundation.

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Authors and Affiliations

  1. Division of Pediatric Cardiology, Department of Pediatrics, University of Miami Miller School of Medicine, 1611 NW 12th Avenue, North Wing # 109, Miami, FL, 33136, USA

    Melissa B. Diamond

  2. Department of Pediatrics, Wayne State University School of Medicine and the Children’s Research Center of Michigan at the Children’s Hospital of Michigan, 3901 Beaubien Boulevard, Suite 1K40, Detroit, MI, 48201, USA

    Steven E. Lipshultz & Vivian I. Franco

  3. Division of Pediatric Cardiology, Department of Pediatrics, Wayne State University School of Medicine and the Children’s Hospital of Michigan, 3901 Beaubien Boulevard, Detroit, MI, 48201, USA

    Sanjeev Aggarwal

  4. Department of Pediatric Hematology-Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, NB10.228, Dallas, TX, 75390-8573, USA

    Kasey Leger

  5. Department of Cardiology and Pediatric Oncology, Instituto de Oncologia Pediátrica/GRAACC, Federal University of São Paolo UNIFESP, 743, Rua Botucatu-Vila Clementino, São Paulo, SP, 04.023-062, Brazil

    Maria Verônica Santos

  6. Division of Pediatric Oncology, Department of Pediatrics, Harvard Medical School and Boston Children’s Hospital, Dana-Farber Cancer Institute, 44 Binney Street Dana 1642, Boston, MA, 02115, USA

    Stephen E. Sallan

  7. Department of Pediatrics, Seattle Children’s Hospital, Fred Hutchinson Cancer Research Center, University of Washington, 1100 Fairview Avenue N, M4-C308, PO Box 19024, Seattle, WA, 98109, USA

    Eric J. Chow

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Lipshultz, S.E., Diamond, M.B., Franco, V.I. et al. Managing Chemotherapy-Related Cardiotoxicity in Survivors of Childhood Cancers. Pediatr Drugs 16, 373–389 (2014). https://doi.org/10.1007/s40272-014-0085-1

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