Cardio-Toxicity during chemotherapy: feasibility of new diagnostic approaches

Fable Zustovich, Mario Trivellato, Renato Ceravolo, Davide Pastorelli, Rosanna Canton, Lorena Buratin, Monica Mion, Martina Zaninotto, Martina Mattiazzi, Mario Plebani, Giuseppe Cartei
DOI: 10.4236/health.2010.24056                

Abstract

Chemotherapy induced cardio-toxicity is a well known side effect of anticancer treatments, moreover the 70% of all tumors involve patients over 65 years-old, frequently with cardiac co- morbidity. We evaluated the feasibility of the application during chemotherapy administration of some of the most recent diagnostic techniques as 12-diagnostic leads telemetry, 7 days EKG monitoring device (R-Test Evolution 3R), blood level dosage of Brain Natriuretic Peptide (BNP) and Ischemia Modified Albumin (IMA). Some sub-clinical changes in the investigated parameters were found in patients undergoing chemotherapy, mostly containing fluorouracil, as shown in the following paper. Far from suggesting a widespread use of these methods during chemotherapy administration, we think that some more tools are needed to prevent cardiac toxicity in high-risk patients and some of what we studied may deserve further valuation in chemotherapy clinical trials.

Keywords

Cardio-Toxicity Diagnostic

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Floyd, J.D., Nguyen, D.T., Lobins, R.L., Bashir, Q., Doll, D.C. and Perry, M.C. (2005) Cardiotoxicity of cancer therapy. Journal of Clinical Oncology, 23, 7685-96.
[2]	Trivellato, M., Cartei, G., Pastorelli, D., Ceravolo, R., Canton, R., Buratin, L. and Bano, C. (2003) Lung cancer chemotherapy and 12-leads EKG telemetry: Preliminary EKG data. Prooceedings of the 10th World Conference on Lung Cancer, Lung Cancer, 41(Suppl 2), 16.
[3]	Trivellato, M., Zustovich, F., Bano, C., Canton, R., Buratin, L., Pastorelli, D., Ceravolo, R., Binato, S., Salmaso, F., Zovato, S., Caliandro, A., Michielin, R. and Cartei, G. (2005) Twelve-diagnostic-leads EKG telemetry during infusion of folate modulated 5-fluorouracil in patients with colo-rectal malignancies (abstract). Proceedings of Associazione Italian di Oncologia Medica, Annals of Oncology, 16(suppl 7), 21.
[4]	Alter, P., Herzum, M., Soufi, M., Schaefer, J.R. and Maisch, B. (2006) Cardiotoxicity of 5-fluorouracil. Cardiovascular and Hematological Agents in Medicinal Chemistry, 4, 1-5.
[5]	Trivellato, M., Zustovich, F., Canton, R., Buratin, L., Pastorelli, D., Ceravolo, R., Binato, S., Salmaso, F., Zovato, S., Caliandro, A., Michielin, R. and Cartei, G. (2004) High incidence of EKG changes in patients treated with 5FU protracted infusion evidenced by a new 7-days-EKG-monitoring device (R-Test Evolution 3TM). Proceedings of European Society of Medical Oncology, Annals of Oncology, 15(Suppl 3), 407.
[6]	Maisel, A. (2006) The coming of age of natriuretic peptides: The emperor does have clothes! Journal of the American College of Cardiology, 47, 61-64.
[7]	Trivellato, M., Zustovich, F., Canton, R., Buratin, L., Pastorelli, D., Ceravolo, R., Binato, S., Salmaso, F., Zovato, S., Caliandro, A., Michielin, R. and Cartei, G. (2004) Brain natriuretic peptide: A new marker of cardiac ischemia in neoplastic patients during chemotherapy? Proceedings of the 15th International Congress on anti- cancer Treatment.
[8]	Trivellato, M., Zustovich, F., Zaninotto, M., Mion, M., Ceravolo, R., Pastorelli, Canton, R., Buratin, L., Caliandro, A., Michielin, R., Plebani, M. and Cartei, G. (2005) Ischemia Modified Albumin (IMA), brain natriuretic peptide and chromogranin a after fluorouracil bolus in colo-rectal cancer patients. Proceedings of European Society of Medical Oncology GI Symposium, Advances in Gastrointestinal Cancers.
[9]	Collinson, P.O., Gaze, D.C., Bainbridge, K., Morris, F., Morris, B., Price, A. and Goodacre, S. (2006) Utility of admission cardiac troponin and “Ischemia Modified Albumin” measurements for rapid evaluation and rule out of suspected acute myocardial infarction in the emergency department. Emergency Medicine Journal, 23, 256-261.
[10]	Omland, T., Dickstein, K. and Syversen, U. (2003) As- sociation between plasma chromogranin A concentration and long-term mortality after myocardial infarction. American Journal of Medicine, 114, 25-30.
[11]	Schnabel, R., Lubos, E., Rupprecht, H.J., Espinola-Klein, C., Bickel, C., Lackner, K.J., Cambien, F., Tiret, L., Munzel, T. and Blankenberg, S. (2006) B-type natriu- retic peptide and the risk of cardiovascular events and death in patients with stable angina: Results from the Athero Gene study. Journal of the American College of Cardiology, 47, 552-8.
[12]	Jemal, A., Murray, T., Samuels, A., Ghafoor, A., Ward, E. and Thun, M.J. (2003) Cancer statistics. CA Cancer Journal for Clinicians, 53, 5-26.
[13]	O’Connell, M.J., Maillard, J.A., Kahn, M.J., Macdonald, J.S., Haller, D.G., Mayer, R.J. and Wieand, H.S. (1997) Controlled trial of fluorouracil and low-dose leucovorin given for 6 months as postoperative adjuvant therapy for colon cancer. Journal of Clinical Oncology, 15, 246-50.
[14]	Boeyer, F.J.F., Osanto, S., Ritsema, van Eck, H.J., A.Q.M.J., van Steijn, Ballieux, B.E.P.B., Schoemaker, R.C., Cohen, A.F. and Burgraaf (2008) Evaluation of biomarkers for cardio toxicity of anthracyclin-based che- motherapy. Journal of Cancer Research and Clinical Oncology, 134, 961-968.