Pediatric Drugs

, Volume 16, Issue 5, pp 373–389 | Cite as

Managing Chemotherapy-Related Cardiotoxicity in Survivors of Childhood Cancers

  • Steven E. Lipshultz
  • Melissa B. Diamond
  • Vivian I. Franco
  • Sanjeev Aggarwal
  • Kasey Leger
  • Maria Verônica Santos
  • Stephen E. Sallan
  • Eric J. Chow
Review Article

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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Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Steven E. Lipshultz
    • 2
  • Melissa B. Diamond
    • 1
  • Vivian I. Franco
    • 2
  • Sanjeev Aggarwal
    • 3
  • Kasey Leger
    • 4
  • Maria Verônica Santos
    • 5
  • Stephen E. Sallan
    • 6
  • Eric J. Chow
    • 7
  1. 1.Division of Pediatric Cardiology, Department of PediatricsUniversity of Miami Miller School of MedicineMiamiUSA
  2. 2.Department of PediatricsWayne State University School of Medicine and the Children’s Research Center of Michigan at the Children’s Hospital of MichiganDetroitUSA
  3. 3.Division of Pediatric Cardiology, Department of PediatricsWayne State University School of Medicine and the Children’s Hospital of MichiganDetroitUSA
  4. 4.Department of Pediatric Hematology-OncologyUniversity of Texas Southwestern Medical CenterDallasUSA
  5. 5.Department of Cardiology and Pediatric Oncology, Instituto de Oncologia Pediátrica/GRAACCFederal University of São Paolo UNIFESPSão PauloBrazil
  6. 6.Division of Pediatric Oncology, Department of PediatricsHarvard Medical School and Boston Children’s Hospital, Dana-Farber Cancer InstituteBostonUSA
  7. 7.Department of Pediatrics, Seattle Children’s Hospital, Fred Hutchinson Cancer Research CenterUniversity of WashingtonSeattleUSA

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