DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20195005

Comparison of standard short infusion versus prolonged infusion of Doxorubicin in relation to its cardiotoxicity in South Indian population

Roshan Koshy Jacob, Shashidhar V. Karpurmath, Manjunath Nandennavar, Veerendra Angadi

Abstract


Background: Anthracycline is one of the commonly used chemotherapeutic agents in the treatment of malignancies and their efficacy is undermined by potential life-threatening cardiotoxicity.  The aim of this study is to compare the cardiotoxicity in patients receiving standard short infusion (15-30 minutes) versus prolonged infusion (6 hours) of doxorubicin in the study group.

Methods: In this study 80 patients who were planned for treatment with Doxorubicin >200 mg/m2 were included in this study and they were randomly allotted to either of the treatment group. Each patient was assessed clinically (History, Pulse rate, Blood pressure) along with ECG ,ECHO prior to initiation of chemotherapy, after completion of 200 mg/m2 of Doxorubicin, 3 months and 6 months after chemotherapy.

Results: There were 40 patients in each group, and they received a total of 384 cycles of Doxorubicin containing regimens according to respective protocols. The median number of cycles was four (range four to six cycles). The mean cumulative dose of doxorubicin was 271.5 mg/m2 in the group which received standard short infusion and 264 mg/m2 in the group which received the drug by prolonged infusion. However, none of the patients developed any cardiac symptoms during or after the planned chemotherapy nor was there a drop in ejection fraction on serial ECHO.

Conclusions: There was no benefit of prolonged infusion of doxorubicin as compared to the standard rapid infusion in terms of doxorubicin induced cardiotoxicity. At present, standard rapid infusion is the best option.

Keywords


Cardiotoxicity, Doxorubicin, ECHO, Infusion

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References


Aapro M, Bernard-Marty C, Brain EG, Batist G, Erdkamp F, Krzemieniecki K, et al. Anthracycline cardiotoxicity in the elderly cancer patient: a SIOG expert position paper. Ann Oncol. 2010 Oct 18;22(2):257-67.

Hershman DL, Shao T. Anthracycline cardiotoxicity after breast cancer treatment. Breast Cancer. 2009 Mar 16;23(3):227-34.

Cardinale D, Colombo A, Bacchiani G, Tedeschi I, Meroni CA, Veglia F, et al. Early detection of anthracycline cardiotoxicity and improvement with heart failure therapy. Circulation. 2015 Jun 2;131(22):1981-8.

Smith LA, Cornelius VR, Plummer CJ, Levitt G, Verrill M, Canney P, et al. Cardiotoxicity of anthracycline agents for the treatment of cancer: systematic review and meta-analysis of randomised controlled trials. BMC cancer. 2010 Dec;10(1):337.

Shapira J, Gotfried M, Lishner M, Ravid M. Reduced cardiotoxicity of doxorubicin by a 6‐hour infusion regimen. A prospective randomized evaluation. Cancer. 1990 Feb 15;65(4):870-3.

Rosner, Bernard A. Fundamentals of Biostatistics. 5th Edition. Duxbury:80-240.

Riffenburgh R H. Statistics in Medicine. Second edition, Academic Press: 85-125.

Rao S , Richard J. An Introduction to Biostatistics- A manual for students in health sciences. Fourth edition , New Delhi: Prentice hall of India: 86-160.

Suresh K.P, Chandrasekhar S, Sample Size estimation and Power analysis for Clinical research studies. J Human Reproduction Sci. 2012;5(1):7-13.

Vejpongsa P, Yeh ET. Prevention of anthracycline-induced cardiotoxicity: challenges and opportunities. J Am College Cardiol. 2014 Sep 2;64(9):938-45.

Popov I, Jelić S, Radulović S, Radosavljević D, Nikolić-Tomašević Z. Eight-hour infusion versus bolus injection of doxorubicin in the EAP regimen in patients with advanced gastric cancer: A prospective randomised trial. Ann Oncol. 2000 Mar 1;11(3):343-8.

Van Dalen EC, van der Pal HJ, Caron HN, Kremer LC. Different dosage schedules for reducing cardiotoxicity in cancer patients receiving anthracycline chemotherapy. Cochrane Database Systematic Reviews. 2009(4):1-53.

Quintana RA, Banchs J, Gupta R, Lin HY, Raj SD, Conley A, et al. Early evidence of cardiotoxicity and tumor response in patients with sarcomas after high cumulative dose doxorubicin given as a continuous infusion. Sarcoma. 2017;2017:1-6.