Comparison of doxorubicin cardiotoxicity in pediatric patients when given with dexrazoxane versus a continuous infusion

Abstract

9044 Background: Despite the effectiveness of doxorubicin (D) in sarcomas, its use is limited by cardiotoxicity. Both delivery by continuous infusion (CI) and use of the cardioprotectant dexrazoxane (Z) have been used to reduce cardiotoxicity. Since 1998 patients with Ewing’s sarcoma seen at MDACC have been treated with a total of 540 mg/m2 D given with Z (ZD). During this period patients with osteosarcoma have been treated with 360–540 mg/m2 D given as a 48-hour infusion (CID). Methods: To compare the cardiotoxicity of ZD versus CID, we did a retrospective review of patients seen on the pediatric service at MDACC since 1998. Patients included needed to have had 1) planned therapy of at least 360 mg/m2 D, given either as ZD or CID; 2) measurement of ejection fraction (EF) prior to any D; and 3) routine monitoring of cardiotoxicity with EF. Patients were recorded as having cardiotoxicity for any EF<50% or clinical symptoms. Groups were compared by 2-sided t-test and Fisher’s Exact test. Results: A total of 64 patients were treated with ZD or DCI, 52 of which are evaluable. Comparison of ZD to CID showed no significant difference in age or male:female ratio. Total D dose was higher in ZD. Cardiotoxicity was higher in DCI as determined by number of patients with cardiotoxicity and EF on worst Echo. Conclusions: Despite the higher total dose of D, patients treated with ZD had less cardiotoxicity. Whether this is due to giving a cardioprotectant or other factors, such as, higher degree of electrolyte abnormalities or greater degree of anemia in patients treated with CID needs to be investigated. [Table: see text] No significant financial relationships to disclose.