الفهرس 
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Abstract
SUMMARY
C
ancer is considered a major public health problem in our country and many other parts of the world. The number of cancer survivors continues to increase due to aging and growth of the population and improvements in early detection and treatment. Modern comprehensive management of cancer patients including surgery, chemotherapy and radiotherapy, has resulted in prolonged cancer-related survival, but treatment-related cardiotoxicity remains a major concern in this population.
The primary cause of chemotherapy-induced cardiotoxicity is anthracycline compounds, which are used extensively to treat lymphoma, sarcoma, breast cancer, and pediatric leukemia. The prevention of anthracycline-induced cardiotoxicity is an important challenge in cancer survivorship. The incidence and severity of anthracycline-induced cardiomyopathy are associated with the cumulative dose of the chemotherapeutic agent. Once clinically apparent, anthracycline-induced cardiomyopathy is often irreversible and potentially lethal.
Acute cardiotoxicity during therapy is rare, not dose-related, and often associated with pre-existing cardiac diseases. More common and by far more serious is chronic cardiotoxicity, which can occur weeks or even years after treatment. In more than 50% of patients who survived childhood leukemia echocardiographic abnormalities are detectable after anthracycline-based therapeutic regimen. chronic cardiotoxicity usually manifests during the first year after the end of anthracycline treatment but can also occur decades later.
Statins have been shown to reduce morbidity and mortality in patients with atherosclerotic diseases; also many studies showed that statins have other cholesterol-independent or “pleiotropic” effects which include improving of endothelial function, enhancing the stability of atherosclerotic plaques, decreasing oxidative stress, and inflammation. Some of the cardiac adverse effects of chemotherapy drugs are triggered by cardiac oxidative stress and inflammation. Previous studies have revealed that treatment with statins may decrease the risk of chemotherapy-induced cardiotoxicity without compromising treatment efficacy.
The main objective of the current study was to evaluate the effect of statin therapy on the prevention of anthracycline-induced cardiotoxicity in female patients with breast cancer.
The current study was a prospective, randomized, single-blind, placebo-controlled trial that included a total of 100 female patients with newly diagnosed breast cancer who received anthracycline-based chemotherapy.
Eligible Patients were randomly assigned in a 1:1 ratio into two groups, the study group in which patients received 40 mg of oral atorvastatin prior to the first cycle of chemotherapy and then once daily during the whole follow-up period, and the control group in which patients received a placebo prior to the first cycle of chemotherapy and during the whole follow-up period.
The primary endpoint of the current study was the development of cancer therapy-related cardiac dysfunction (CTRCD) defined as a DROP in LV ejection fraction of more than 10% and to a value below 53% measured by 3D- echocardiography.
In the current study, there was a significant difference between the two groups regarding the incidence of CTRCD, among the control group 15 patients (30%) developed CTRCD after 6 months from starting Anthracyclines based chemotherapy, while, among the intervention group only 6 patients (12%) developed CTRCD denoting that prophylactic use of atorvastatin may prevent the development of cancer therapy-related cardiac dysfunction in breast cancer patients receiving anthracycline-based chemotherapy.
Based on the results of the current study, we recommend that breast cancer patients receiving anthracycline-based chemotherapy -without contraindication to statin therapy- should be kept on statins, especially, those at higher risk for development of cancer therapy-related cardiac dysfunction (patients with low EF before starting chemotherapy, high baseline LDL-C levels, and those planned to receive both anthracyclines and Herceptin).