Study on Cardiotoxicity Risks in Childhood Cancer Survivors

Overview of Pediatric Cancer in Canada

A recent study published in JAMA Oncology examined data from over 28,000 childhood cancer survivors to assess the lifetime risk of cardiotoxicity associated with various chemotherapeutic agents. In Canada, one in five children diagnosed with childhood cancer does not survive. Pediatric cancer can impact any organ and is among the leading causes of childhood mortality in the country. Chemotherapy remains a primary treatment for these cancers, significantly increasing survival rates but often resulting in severe long-term side effects.

The Impact of Childhood Cancer Treatment

Almost 30,000 childhood cancer survivors in Canada face numerous toxic and undesirable long-term effects from their treatments. Approximately 75% of these survivors develop one or more chronic conditions that notably diminish their quality of life. This situation highlights the urgent need to develop less aggressive chemotherapy regimens and accurately assess the chronic side effects caused by these medications.

Understanding Anthracyclines in Pediatric Chemotherapy

Mainstay of Treatment

Anthracyclines, including doxorubicin, danorubicin, epirubicin, and mitoxantrone, represent a cornerstone of chemotherapy protocols for pediatric cancers. However, determining the overall toxicity of these drugs remains contentious. Most anthracyclines are known to cause cardiotoxicity, which can lead to heart muscle abnormalities and compromised cardiac function.

Challenges in Assessing Cardiotoxicity

Given the variety of toxic side effects these drugs can induce and their application at different doses across numerous pediatric cancer subtypes, accurately comparing and estimating the lifetime risk of cardiotoxicity is complex.

Research Findings on Cardiotoxicity

Collaboration and Study Goals

Researchers from Fred Hutchinson Cancer Research Center in Seattle, St. Jude Children’s Research Hospital in Memphis, Duke University School of Medicine in Raleigh-Durham, and the University of Washington, along with colleagues from the Netherlands, conducted a study to evaluate the cardiotoxicity risk of various anthracycline chemotherapy drugs. Their findings were published in JAMA Oncology.

Key Results of the Study

The analysis included data from over 28,000 childhood cancer survivors who had been treated for conditions such as leukemia, lymphomas, brain tumors, neuroblastoma, kidney tumors, bone tumors, and soft tissue sarcomas. The study concluded that danorubicin presents a lower risk of cardiotoxicity compared to doxorubicin, while mitoxantrone exhibits a higher cardiotoxicity risk than doxorubicin. The cardiotoxicity of epirubicin is comparable to that of doxorubicin. The authors emphasized the need to consider long-term cardiotoxicity risks when designing chemotherapy regimens for pediatric cancers to enhance the survivors’ quality of life.

Conclusion

This study sheds light on the importance of evaluating cardiotoxicity risks associated with chemotherapy drugs used in treating childhood cancers. By prioritizing safer treatment options, healthcare providers can significantly improve the long-term outcomes and quality of life for survivors.

References

Feijen, E. A. M., Leisenring, W. M., Stratton, K. L., Ness, K. K., van der Pal, H. J. H., van Dalen, E. C., … Chow, E. J. (2019). Derivation of Anthracycline and Anthraquinone Equivalence Ratios to Doxorubicin for Late-Onset Cardiotoxicity. JAMA Oncol. doi:10.1001/jamaoncol.2018.6634
https://www.kidscancercare.ab.ca/childhood-cancer/stats
https://www.eurekalert.org/pub_releases/2019-01/uoth-dac013119.php