About half of children with cancer are treated with anthracycline chemotherapy, such as doxorubicin and daunorubicin. These chemotherapy drugs have often proven effective but can cause serious side effects such as heart damage. This can lead to reduced pumping power of the heart. Previous research showed that the drug dexrazoxane can prevent or reduce heart damage. Esmée de Baat: ‘There were concerns about the safety of dexrazoxane, especially regarding the development of second tumors. In addition, there were hardly any guidelines for the use of this drug in children.'
International guideline
To reach global consensus for use of the drug, an international group of pediatric oncologists, pediatric cardiologists, pharmacists and methodologists first conducted a systematic review of existing literature in children and adults. With these insights, they developed an international evidence-based guideline for the use of dexrazoxane in children with cancer who are expected to receive anthracyclines. Esmée de Baat: ‘Once the treatment protocol of a child is clear, we make an estimate of the total anthracycline dose. Because the risk of heart damage increases with higher anthracycline doses, two separate risk groups have been defined.'
Practice
Esmée explains the guideline in practice: 'For children who will receive an anthracycline dose of 250 mg/m2 or more and are at higher risk of developing heart damage, physicians can consider treatment with dexrazoxane. In consultation with child and parents, it is important to weigh the risks and benefits of dexrazoxane for the child's specific situation and determine medical policy. The second group consists of children who will receive less than 250 mg/m2 of anthracyclines with a low to moderately increased risk of heart damage. It was not possible to make a recommendation for the use of dexrazoxane for this group. That’s because we do not yet know whether the possible side effects outweigh the benefit of dexrazoxane, as its mechanism of action has hardly been studied at lower anthracycline doses.'
Long-term effects
Esmée de Baat concludes: 'We are pleased with the new guideline for children receiving high doses. Further research is still needed on topics including the long-term effects of dexrazoxane, the effects at lower anthracycline doses and which children benefit most from treatment with dexrazoxane.' She proudly adds: ‘We will present the new guideline this Friday at the annual SIOP congress, the international congress for pediatric cancer, and at the first international pediatric cardio-oncology congress in October.’
Read the article in The Lancet here.
International guideline
To reach global consensus for use of the drug, an international group of pediatric oncologists, pediatric cardiologists, pharmacists and methodologists first conducted a systematic review of existing literature in children and adults. With these insights, they developed an international evidence-based guideline for the use of dexrazoxane in children with cancer who are expected to receive anthracyclines. Esmée de Baat: ‘Once the treatment protocol of a child is clear, we make an estimate of the total anthracycline dose. Because the risk of heart damage increases with higher anthracycline doses, two separate risk groups have been defined.'
Practice
Esmée explains the guideline in practice: 'For children who will receive an anthracycline dose of 250 mg/m2 or more and are at higher risk of developing heart damage, physicians can consider treatment with dexrazoxane. In consultation with child and parents, it is important to weigh the risks and benefits of dexrazoxane for the child's specific situation and determine medical policy. The second group consists of children who will receive less than 250 mg/m2 of anthracyclines with a low to moderately increased risk of heart damage. It was not possible to make a recommendation for the use of dexrazoxane for this group. That’s because we do not yet know whether the possible side effects outweigh the benefit of dexrazoxane, as its mechanism of action has hardly been studied at lower anthracycline doses.'
Long-term effects
Esmée de Baat concludes: 'We are pleased with the new guideline for children receiving high doses. Further research is still needed on topics including the long-term effects of dexrazoxane, the effects at lower anthracycline doses and which children benefit most from treatment with dexrazoxane.' She proudly adds: ‘We will present the new guideline this Friday at the annual SIOP congress, the international congress for pediatric cancer, and at the first international pediatric cardio-oncology congress in October.’
Read the article in The Lancet here.