The role of cardioprotective medications for prevention of anthracycline-associated cardiotoxicity in adults: review

Anthracycline-based chemotherapy is a major component of adjuvant chemotherapy for breast cancer and a required part of curative combination chemotherapy for acute leukemia, Hodgkin disease, non-Hodgkin lymphoma, and several solid tumors. However, its use is associated with an increased risk of developing ventricular dysfunction which may be irreversible. There are several mechanisms, such as elevation in free superoxide anion radicals, apoptosis, and mitochondrial dysfunction which may be implicated in anthracycline-induced cardiomyopathy. Several strategies for the primary prevention of anthracycline-induced cardiotoxicity have been introduced. These strategies have primarily concentrated on either decreasing the risk of cardiotoxicity potency (using less cardiotoxic derivatives, continuous infusion, or liposomal encapsulation) or administrating cardioprotective agents such as dexrazoxane, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta blockers, and statins. However, cardioprotective treatment with these medications still requires a demonstration of efficacy in large clinical trials. Dexrazoxane is the only cardioprotective agent with proven efficacy in patients undergoing anthracycline-based chemotherapy. Cancer patients receiving anthracycline therapy require regular monitoring of left ventricular ejection fraction prior to, during and after chemotherapy.