Anthracycline cardiotoxicity in the elderly cancer patient: a SIOG expert position paper — Ann Oncol

Anthracycline cardiotoxicity in the elderly cancer patient: a SIOG expert position paper
M. Aapro1, C. Bernard-Marty2, E. G. C. Brain3,*, G. Batist4, F. Erdkamp5, K. Krzemieniecki6, R. Leonard7, A. Lluch8, S. Monfardini9, M. Ryberg10, P. Soubeyran11 and U. Wedding12

Ann Oncol (2011) 22 (2): 257-267.
doi: 10.1093/annonc/mdq609
First published online: October 18, 2010


+ Author Affiliations
1Institut Multidisciplinaire d'Oncologie, Clinique de Genolier, Genolier, Switzerland
2Department of Medical Oncology, Institut Claudius Regaud, Toulouse
3Department of Medical Oncology, Institut Curie/Hôpital René Huguenin, Saint-Cloud, France
4Department of Oncology, McGill University, Montreal, Canada
5Department of Internal Medicine, Maasland Hospital, Sittard, The Netherlands
6Department of Oncology, Jagiellonian University, Krakow, Poland
7Department of Cancer Services and Clinical Haematology, Charing Cross Hospital, London, UK
8Department of Haematology and Medical Oncology, University Hospital of Valencia, Valencia, Spain
9Department of Medical Oncology, Istituto Oncologico Veneto, Padova, Italy
10Department of Medical Oncology, Herlev Hospital, Herlev, Denmark
11Department of Medical Oncology, Institut Bergonié, Bordeaux, France
12Klinik für Innere Medizin II, University Clinic Jena, Jena, Germany


*Correspondence to: Dr E. G. C. Brain, Department of Medical Oncology, Institut Curie/Hôpital René Huguenin, Saint-Cloud, France. Tel: +33-1-47-11-18-75; Fax: +33-1-47-11-16-29; E-mail: brain@crh1.org

Received December 18, 2009.
Revision received August 31, 2010.
Accepted September 3, 2010.


Abstract

Background: Comorbidities and risk factors likely to complicate treatment are common in elderly cancer patients. Anthracyclines remain the cornerstone of first-line therapy for non-Hodgkin’s lymphoma (NHL) and metastatic and early breast cancer but can cause congestive heart failure. Elderly patients are at increased risk of this event and measures to reduce it should be considered.

Methods: A committee of experts in breast cancer and NHL met under the auspices of the International Society for Geriatric Oncology to review the literature and make recommendations, based on level of evidence, for the assessment, treatment and monitoring of elderly patients requiring anthracyclines.

Results and recommendations: Use of anthracycline-based chemotherapy illustrates many of the dilemmas facing elderly cancer patients. Age in itself should not prevent access to potentially curative treatment or treatment that prolongs life or improves its quality. The risk of cardiotoxicity with conventional anthracyclines is increased by the following factors: an existing or history of heart failure or cardiac dysfunction; hypertension, diabetes and coronary artery disease; older age (independent of comorbidities and performance status); prior treatment with anthracyclines; higher cumulative dose of anthracyclines and short infusion duration. The fact that cumulative and irreversible cardiotoxicity is likely to be greater in this population than among younger patients calls for effective pretreatment screening for risk factors, rigorous monitoring of cardiac function and early intervention. Use of liposomal anthracycline formulations, prolonging the infusion time for conventional anthracyclines and cardioprotective measures should be considered. However, when treatment is being given with curative intent, care should be taken to ensure reduced cardiotoxicity is not achieved at the expense of efficacy.

full-text:
Anthracycline cardiotoxicity in the elderly cancer patient: a SIOG expert position paper — Ann Oncol