HHE Sponsored handbook: Cardioprotection in clinical | Page 3

HHE 2019 3
Anthracyclines
Anthracyclines are widely prescribed anticancer
agents and remain an important component of
treatment guidelines. 1–3
Anthracyclines have been shown to be
associated with dose-related cardiotoxicity. 1,3–11
Cardiotoxicity
Acute cardiotoxicity occurs in <1% of patients
immediately after infusion; early-onset chronic
progressive cardiotoxicity presents in 1.6–2.1%
of patients, and late-onset chronic progressive
cardiotoxicity has been reported in 1.6–5%
of patients. 4 This anthracycline-induced
cardiotoxicity can impact patients’ treatment
and quality of life. 8,12–14
Cardioxane® (dexrazoxane): Prevention of
anthracycline-related cardiotoxicity
Cardioxane ® is indicated in adults for the
prevention of chronic cumulative cardiotoxicity
caused by anthracycline use in advanced and/or
metastatic breast cancer patients who have
received a prior cumulative dose of 300mg/m 2
doxorubicin or a prior cumulative dose of
540mg/m 2 epirubicin when further anthracycline
treatment is required.
Use in children and adolescents aged 0–18
years is contraindicated unless they are expected
to receive a cumulative anthracycline dose
equivalent to 300mg/m 2 doxorubicin. The safety
and effi cacy of Cardioxane ® in children aged 0–18
years have not been established.
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FIGURE 1A
Dexrazoxane protects against FAC-induced cardiac events in patients
with advanced breast cancer 1
1.0
0.8
0.6
Dexrazoxane
0.4
HR for cardiac event: 3.51
95% Cl: 2.15–5.72
p<0.001
0.2
0.0
Dexrazoxane 102
Placebo
99
300
Placebo
89
92
53
52
500
36
17
29
7
700
17
3
10
1
900
7
1
5
1
1100
3
1
2
1
1300
2
1
1
1500
Study design: All patients received six courses of fl uorouracil, doxorubicin and cyclophosphamide (FAC) plus placebo,
total doxorubicin dose 300mg/m 2 . Thereafter they received FAC plus dexrazoxane (n=102) or placebo (n=99).
There was no diff erence between groups at baseline in terms of cardiac risk factors. Cardiac events were defi ned
as congestive heart failure (CHF) or a decline in left ventricular ejection fraction from baseline ≥20% or from baseline
≥10% and to a value below the lower limit of normal (LLN) or to a value ≥5% below the LLN