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Cardiac (Heart) Toxicity

Side effects and toxicity of the chemotherapy drugs remain the most important barriers to usage of higher doses of these agents, possibly causing a reduction in their efficacy.

Certain drugs can damage the heart, if used in excessive amounts. These are:

• Adriamycin

• Daunorubicin

• Mitoxantrone

There are a few of the other drugs which may have a minimal adverse effect on the heart, but not as severe or as common as the above medicines.

Cardiac toxicity of Adriamycin limits the total dose of the medicine that may be used safely. The patients who are to start on Adriamycin should be evaluated for possibility of preexisting heart problems. The best test to evaluate the heart is a MUGA Scan. Patients with prior history of heart attack or any other form of heart condition may not be candidates for treatment with Adriamycin.

Every patient who has to be treated with Adriamycin should undergo a MUGA scan prior to treatment or very shortly thereafter. A MUGA scan should be repeated during and after completion of chemotherapy, as well.

More recently, a new drug, Zinecard, was approved to reduce the cardiac side effects of Adriamycin. Another approach to prevent the cardiac side effects of Adriamycin has lead into development of Liposomal Packaged medicines, (DaunoXome, Doxil)

Mitoxantrone, on the other hand, can be used as a substitute for Adriamycin. This drug is less cardiac toxic and better tolerated.

Signs and Symptoms:

Some patients, despite proper management, may develop heart damage from these drugs. They may experience:

• Shortness of breath

• Cough

• Loss of energy

• Irregular heartbeat

Diagnosis:

A repeat MUGA scan, or ultrasound of the heart may disclose the diagnosis.

Treatment of Heart Problems:

The causing chemotherapy drug must be terminated and never used again. Patients may have to be hospitalized and treated with appropriate heart medicines.