chemotherapy associated cardiomyopathy

Cardiomyopathy

Damage to heart muscle leading to decrease in LVEF and subsequent heart failure

Name the leading cause of death in breast cancer pts +66 years old (outside of breast cancer)

CVD

T/F: age > 60 is a risk factor for chemotherapy-associated cardiomyopathy

True

T/F: pediatric oncology patients is a risk factor for chemotherapy-associated cardiomyopathy

True

T/F: pre-existing cardiac disease is a risk factor for chemotherapy-associated cardiomyopathy

True

T/F: radiation therapy to the chest wall is a risk factor for chemotherapy-associated cardiomyopathy

True

T/F: anthracycline based chemotx is a risk factor for chemotherapy-associated cardiomyopathy

True

T/F: trastuzumab + doxorubicin combination use is a risk factor for chemotherapy-associated cardiomyopathy

True

T/F: cardiotoxin medications used in combo that cause QTc prolongation is a risk factor for chemotherapy-associated cardiomyopathy

True

T/F: age < 60 is a risk factor for chemotherapy-associated cardiomyopathy

False

T/F: taxane based chemotherapy is a risk factor for chemotherapy-associated cardiomyopathy

False

Chemotx agent that causes type 1 chemo tx induced CM

Doxorubicin (anthracyclines)

Chemotx agent that causes type II chemo tx induced CM

Anti HER2 agents

Which type of chemotx induced CM is IRREVERSIBLE?

Type I

Type I chemotherapy induced CM cause (not the drug itself)

Cumulative dose-dependent

Best prevention strategy for preventing anthracycline induced CM

Use dexrazoxane

Best prevention strategy for preventing anti-HER2 agent induced CM

Sequential tx

Two medications that can cause QT prolongation

Ondansetron and methadone

Risk factors for chemotherapy induced CM

1. High dose anthracycline (doxorubicin > 250 mg/m² and epirubicin > 600 mg/m² )

2. Lower dose anthracycline followed by trastuzumab (sequential)

3. Lower dose anthracycline or trastuzumab alone +

   1. Multiple CV risk factors (+2); smoking , HTN, diabetes, dyslipidemia and obesity

   2. Older age (+60)

   3. Compromised cardiac function (50-55% LVEF)

NCCN recommendation for CM screening (who should get it, what type and how often)

• Who: Pts receiving a cumulative anthracycline dose > 250 mg/m²

• What: echocardiogram

• When: every 1-2 years and before each cycle of chemotherapy ?

Which type of chemo induced CM is cumulative, dose related?

Type I

Which type of chemotx induced CM is safe to re-challenge?

Type II

What is the doxorubicin minimum dose that a pt would be at risk of CM? Maximum (where dose is capped)?

• Minimum: > 250 mg/m²

• Maximum: 450 mg/m² (with RTx) or 550 mg/m² (withOUT RTx)