Laurie Barclay NEW YORK (MedscapeWire) May 07
Two studies in the May issue of Annals of Oncology suggest that new guidelines are needed to monitor anthracycline recipients for heart failure. The first suggests that heart failure may not be evident before 3 months, and that increased risk may persist even after 3 years. The second study suggests that troponin I levels immediately after therapy may predict risk of delayed heart failure. “Due to the displaced cardiotoxic manifestation, functional monitoring in close connection with anthracycline administration appears to be a poorly effective method, while later monitoring is essential,” write Benny V. Jensen, MD, and colleagues from the University of Copenhagen in Denmark. “Current monitoring recommendations should therefore be revised.” In a prospective, blinded, observational study, 120 breast cancer patients had a progressive decrease in left ventricular (LV) function beginning 3 months or more after starting treatment with the anthracycline epirubicin. Cardiotoxicity was closely correlated with the cumulative dose, with considerable variation among the patients and increased susceptibility in older patients. By 3 years after treatment, 59% had experienced a 25% decrease in LV function, and within 5 years, 20% of those treated with high-dose epirubicin had developed severe cardiomyopathy.
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