Dampak Kardiotoksik Obat Kemoterapi Golongan Antrasiklin
Sari
Pengobatan kanker semakin pesat beberapa tahun terakhir dengan pilihan kombinasi obat kemoterapi,
radioterapi dan pembedahan. Salah satu obat kemoterapi yaitu golongan antrasiklin, tetapi obat ini
mempunyai efek samping terhadap jantung yang tergantung dosis kumulatif pemakaian obat. Efek terhadap
jantung dibagi menjadi efek cepat dan lambat. Efek cepat terjadi pada <1% kasus kanker. Sering ditemukan
adalah efek lambat, dan seringkali subklinis. Mekanisme kerja obat diduga melalui proses ikatan dengan
DNA. Setelah pemberian obat intravena kadar obat dalam plasma akan menurun cepat dan bertahan lama
di jaringan, sehingga diperlukan pemantauan seumur hidup. Prosedur diagnostik untuk mendeteksi efek
ini adalah EKG, ekokardiografi, angiografi dan biopsi endomiokardium. Pencegahan yang dapat dilakukan
yaitu penggunaan analog obat, membatasi jumlah obat yang masuk, mencari alternatif cara pemberian
obat, dan pemberian obat yang disertai dengan obat yang melindungi jantung. Tantangan pemberian obat
golongan antrasiklin adalah bagaimana mengurangi efek toksik terhadap jantung sementara efek obat
terhadap kanker tidak berkurang.
Kata Kunci
Teks Lengkap:
PDFReferensi
Ricardi R, Lasorell A, Mastrangelo R. Cardiac toxicity.
Dalam: Voute PA, Kalifa C, Barret A, penyunting.
Cancer in children management, Edisi ke-4. New York:
Oxford, 1990. h. 56-7.
Powis G. Toxicity of free radical forming anticancer
agent. Dalam: Powis G, Hcker MP, penyunting. The
toxicity of anticancer drugs. New York : Pergmon press,
h. 106-19.
Lipshultz SE, Rifi N, Dalton VM. The effect of
dexrazoxane on myocardial injury in doxorubicin treated
children with acute lymphoblastic leukemia. N Engl J
Med 2004; 351:145-53.
Dorup I, Levitt G, Sullivan I, Sorensen K. Prospective
longitudinal assessment of late anthracycline cardiotoxicity
after childhood cancer: the role of diastolic
function. Heart 2004; 90:1214-6.
Mancini DM, Beniaminovitz A. Myocarditis and specific
cardiomiopathies- endocrine disease and alcohol. Dalam:
Fuster V, Alexander RW, O’Rourke RA, penyunting.
Hurst’s the heart, Edisi ke-10. New York : McGraw-
Hill,2001. h. 2021-2.
Allen J, Thompson JDR, Lewis IJ, Gibbs JL. Mitral
regurgitation after anthracycline treatment for childhood
malignancy. Heart 2001: 85:430-2.
Yeh ETH, Tong T, Lenihan DJ. Cardiovascular
complication of cancer therapy, diagnosis, pathogenesis,
and management. Circulation 2004; 109:122-31.
Nakamura T, Ued Y, Jun Y. Fas mediated apoptosis in
adriamycin induced cardiomiopathy in rats. Circulation
; 102:572-8.
Zhu W, Zou Y, Aikw R. MAPK superfamily play an
important role in daunomycin-induced apoptosis of
cardiac myocytes. Circulation 1999; 100:2100-7.
Schwartz CL, Hobbie WL, Truesdell S, Constine LC,
and Clark EB. Corrected QT interval prolongation in
anthracycline-treated survivors of childhood cancer. J
Clin Oncol 1993; 11:1906-10.
Lipshultz SE, Lipsitz SR, Mone SM. Female sex and
higher drug dose as risk factors for late cardiotoxic effects
of doxorubicin therapy for childhood cancer. N Engl J
Med 1995; 332:1738-43.
Kremer LCM, van Dalen EC, Offringa M, Ottenkamp
J, Voute PA. Anthracycline induced clinical heart failure
in a cohort of 607 children: long term follow up study.
J Clin Oncol 2001; 19:191-6.
Acker SABE, Kramer K, Voest EE. Doxorubicin induced
cardiotoxicity monitored by ecg in freely moving mice.
Eur J Ped 1998; 157:464-7.
Thigpen JT. Innovations in anthracycline therapy:
overview. Commun Oncol 2005; 2:3-7.
Khan AC, Srinivasan S, Czuczman MS. Prevention and
management of cardiotoxicity from antineoplastic
therapy. J Support Oncol 2004; 2:251-66.
Nysom K, Holm K, Lipsitz SR. Relationship between
cumulative anthracycline dose and late cardiotoxicity in
childhood acute lymphoblastic leukemia. J Clin Oncol
; 16:545-50.
Hrstkova H, Honztkova N, Fiser B. Baroreflex
sensitivity, blood pressure and heart rate in children and
adolescents after anthracycline treatment for malignant
tumour. Scripta Medica 2002; 74:187-94.
Singl PK, Illiskovic N. Doxorubicin induced
cardiomyopathy. N Engl J Med 1998; 339:900-5
Iarussi D, Indolfi P, Casale F. Recent advances in the
prevention of anthracycline cardiotoxicity in childhood.
Curr Med Chem 2001; 8:1649-60.
Zavodna E, Hrstkova H, Honzikova N. Autonomous
regulation of circulation in children after anthracycline
therapy. Scripta Medica 2002; 75:195-202.
Monfardini S, Brunner K, Crowther D, Eckhardt S.
Dalam: Monfardini S, Brunner K, Crowther D, Eckhardt
S, Olive D, Tanneberger S, Veronesi A, Whitehouse JMA,
Wittes R, penyunting. Basic concepts in cancer
chemotherapy. Springer-Verlag Berlin Heidelberg;
Germany 1987. h. 11-21.
Delgado RM, Nawar MA, Zewail AM. Cyclooxygenase-
inhibitor treatment improves left ventricular function
and mortality in a murine model of doxorubicin induced
heart failure. Circulation 2004; 109:1428-33.
Lebrecht D, Setzer B, Ketelsen UW. Time dependent
and tissue specific accumulation of mtDNA and
respiratory chain defects in chronic doxorubicin
cardiomyopathy. Circulation 2003 ; 108:2423-9.
Cardinale D, Sandri MT, Colombo A. Prognostic value
of troponon I in cardiac risk stratification of cancer
patients undergoing high dose chemotherapy.
Circulation 2004; 109:2749-54.
Tjeerdsma G, Meinardi MT, Graaf WTA. Early
detection of anthracycline induced cardiotoxicity in
asymptomatic patients with normal left ventricular
systolic function: autonomic versus echocardiographic
variables. Heart 1999; 81:419-23.
Acker FAA, Acker SABE, Kramer K. 7 monohydroxyethylrutoside
protects against chronic doxorubicin
induced cardiotoxicity when administered only once
per week. Clin Cancer Res 2000; 6:1337-41.
Hellmann K. Preventing the cardiotoxicity of anthracycline
by dexrazoxane. BMJ 1999; 319:1085-6.
Hashimoto I, Ichida F, Miura M. Automatic border detection
identifies subclinical anthracycline cardiotoxicity in children
with malignancy. Circulation 1999; 99:2367-70.
DOI: http://dx.doi.org/10.14238/sp9.2.2007.151-6
Refbacks
- Saat ini tidak ada refbacks.
##submission.copyrightStatement##
##submission.license.cc.by-nc-sa4.footer##
Email: editorial [at] saripediatri.org
Sari Pediatri diterbitkan oleh Badan Penerbit Ikatan Dokter Anak Indonesia
Ciptaan disebarluaskan di bawah Lisensi Creative Commons Atribusi-NonKomersial-BerbagiSerupa 4.0 Internasional.