Different dosage schedules for reducing cardiotoxicity in cancer patients receiving anthracycline chemotherapy
Editorial Group: Cochrane Gynaecological, Neuro-oncology and Orphan Cancer Group
Published Online: 7 OCT 2009
Assessed as up-to-date: 11 MAY 2009
Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
van Dalen EC, van der Pal HJH, Caron HN, Kremer LCM. Different dosage schedules for reducing cardiotoxicity in cancer patients receiving anthracycline chemotherapy. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD005008. DOI: 10.1002/14651858.CD005008.pub3.
- Publication Status: Edited (no change to conclusions)
- Published Online: 7 OCT 2009
The use of anthracycline chemotherapy is limited by the occurrence of cardiotoxicity. To prevent this cardiotoxicity, different anthracycline dosage schedules have been studied.
To determine the occurrence of cardiotoxicity with the use of different anthracycline dosage schedules (i.e. peak doses and infusion durations) in cancer patients.
We searched the databases of The Cochrane Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 4, 2008), MEDLINE (1966 to November 2008) and EMBASE (1980 to November 2008). Also, we searched reference lists of relevant articles, conference proceedings and ongoing trials databases.
Randomised controlled trials (RCTs) in which different anthracycline dosage schedules were compared in cancer patients (children and adults).
Data collection and analysis
Two authors independently performed the study selection, the risk of bias assessment and the data-extraction.
We identified seven RCTs addressing different anthracycline infusion durations. The meta-analysis showed a statistically significant lower rate of clinical heart failure with an infusion duration of 6 hours or longer as compared to a shorter infusion duration (relative risk (RR) = 0.27; 95% confidence interval (CI) 0.09 to 0.81; 5 studies; 557 patients). The majority of patients included in these studies were adults with different solid tumours. For different anthracycline peak doses we identified two RCTs addressing a doxorubicin peak dose of less than 60 mg/m
An anthracycline infusion duration of six hours or longer reduces the risk of clinical heart failure and it seems to reduce the risk of subclinical cardiac damage. Since there is only a small amount of data for children and data obtained in adults cannot be extrapolated to children, different anthracycline infusion durations should be evaluated further in children.
No significant difference in the occurrence of clinical heart failure was identified in patients treated with a doxorubicin peak dose of less than 60 mg/m
Plain language summary
Different dosage schedules for reducing damage to the heart in cancer patients receiving anthracycline chemotherapy.
Anthracyclines are one of the most effective treatments for various types of cancer. Unfortunately, there is a risk of heart damage depending on the total dose a patient has received. In an effort to prevent this heart damage different anthracycline dosage schedules (like different infusion durations or different individual peak doses) are being used.
Based on the currently available evidence, the authors are not able to favour either a doxorubicin peak dose of less than 60 mg/m