Cardiotoxicity of Doxorubicin in National Centre for Cancer Care and Research (Ncccr) - Qatar

Abstract

Background: National Centre for Cancer Care and Research (NCCCR) is a well equipped centre in Qatar, includes inpatients, day care unit, and outpatients clinics, it contain very modern department of Radiotherapy besides the bone marrow transplantation. DOXORUBICIN is effective against a wide spectrum of cancers, including ALL, AML, Hodgkin's disease, malignant lymphoma, soft tissue and bone sarcoma, thyroid cancer, small lung cancer, breast cancer, gastric cancer, ovarian cancer, bladder cancer, and neuroblastoma. Doxorubicin has acute and delayed cardiotoxicity: Acute cardiotoxicity: occur immediately after drug administration or within one to two days. It includes atrioventricular block, bradycardia, ECG abnormalities, extracystoles (atrial or ventricular), sinus tachycardis, ST-T wave change, supraventricular tachycardia, tachyarrhythmia, and ventricular tachycardia. Delayed cardiotoxicity: start about a year or more after administration, it includes left ventricular ejection fraction (LVEF) decreased, CHF, myocarditis, pericarditis. Factors that affect the cardiotoxicity: • A high dose of doxorubicin. • The simultaneous use of other chemotherapy drugs that affect the heart e.g. high doses of cyclophosphamide • Radiation treatment to the left side of the chest wall. • Already-existing heart disease • Female patients • Younger age. (Table presented) Methods: The objective: reducing of the cardiotoxicity of doxorubicin. Data collected retrospectively. Random sample of 82 patients who have received doxorubicin during the last four years was collected. The sample of the patients included male and female (43% male and 57% female), and their ages were between 23 and 65 years. The reports of echocardiogram have reviewed before and after the treatment for four years. I have focused on the cardiotoxicity which is related to doxorubicin. Also, I have checked if the patients who showed cardiotoxicity received radiotherapy on the left side of the chest wall or not. Cumulative dose for every patient was calculated. Results: Data analysis: No. of patients: 82 patients. Percentage of patient who received cumulative dose more than the recommended is 3.6% (fortunetely, they didn't show cardiotoxicity). Percentage of patients who showed cardiotoxicity during one year is 2.4% (They didn't receive radiotherapy on the left side of the chest wall). Percentage of patients who showed cardiotoxicity after one year and through three years. is 1.2% (They received radiotherapy on the left side of the chest wall). Percentage of male patients who showed cardiotoxicity 1.2 %. Percentage of female patients who showed cardiotoxicity 2.4%. Conclusion: The data analysis showed that the cardiotoxicity of Doxorubicin is 2.4% during the first year after the treatment (they didn't receive radiotherapy on the left side of the chest wall) and 1.2% after one year and during three years (they received radiotherapy on the left side of the chest wall). Recommendation • Keeping the total dose of doxorubicin within safe limits. • Administering the drug as an infusion in saline rather than as a bolus injection. • Using liposomal doxorubicin. • Using a Dexrazoxane (antidote - cardioprotectant), a 10:1 ratio of dexrazoxane: doxorubicin (500mg/m2 dexrazoxane: 50mg/m2 doxorubicin) as an infusion soon after doxorubicin.