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Annals of Oncology Advance Access originally published online on January 19, 2009
Annals of Oncology 2009 20(5):816-827; doi:10.1093/annonc/mdn728
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

reviews

Expert opinion on the use of anthracyclines in patients with advanced breast cancer at cardiac risk

P. J. Barrett-Lee1,*, J. M. Dixon2, C. Farrell3, A. Jones4, R. Leonard5, N. Murray6, C. Palmieri7, C. J. Plummer8, A. Stanley9 and M. W. Verrill10

1 Breast Unit, Velindre Cancer Centre, Cardiff
2 Edinburgh Breast Unit, Western General Hospital, Edinburgh
3 Breast Unit, Christie Hospital NHS Foundation Trust, Manchester
4 Department of Oncology and Radiotherapy, Royal Free Hospital and University College Hospital, London
5 Department of Medical Oncology, Imperial College Hospitals Trust, London
6 Cancer Research UK Clinical Centre, University of Southampton, Southampton
7 Department of Cancer Medicine, Imperial College London, London
8 Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne
9 Department of Oncology, City Hospital, Birmingham
10 Northern Centre for Cancer Treatment, Newcastle General Hospital, Newcastle Upon Tyne, UK

* Correspondence to: Prof. P. J. Barrett-Lee, Breast Unit, Velindre Cancer Centre, Whitchurch, Cardiff CF14 2TL, UK. Tel: 29 20615888 ext: 6384; Fax: 29 20196835; E-mail: peter.barrett-lee{at}velindre-tr.wales.nhs.uk

Anthracyclines are considered to be among the most active agents for the treatment of breast cancer. However, their use is limited by cumulative, dose-related cardiotoxicity. Such cardiotoxicity results in a permanent loss of cardiac myocytes and a progressive reduction in cardiac function following each subsequent dose of anthracycline. Initially, damage to the heart is subclinical; however, increasingly impaired cardiac function can result in cardiovascular symptoms, with serious cardiac injury resulting in chronic heart failure. Since the early detection and treatment of cardiotoxicity can reduce its clinical effects, it is important that oncologists are aware of these adverse effects and manage them appropriately. This review examines the risk factors for anthracycline-associated cardiotoxicity and offers recommendations on strategies to reduce the cardiotoxicity of anthracyclines in the management of patients with advanced breast cancer.

Key words: advanced breast cancer, anthracyclines, cardiac monitoring, cardiotoxicity, liposomal anthracyclines, risk factors

Received for publication October 14, 2008. Accepted for publication October 21, 2008.


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