Target Audience:

Who should attend:

• Clinical faculty from the University of Pittsburgh School of Pharmacy
• Clinical staff pharmacists employed by the University of Pittsburgh Medical Center and deployed throughout the hospital campus in unit based roles and centrally in the department of pharmacy's main pharmacy
• Student pharmacy interns currently working within the department of pharmacy
• Certified Pharmacy Technicians

Educational Objectives:

Upon successful completion of this continuing pharmacy education program, the participant should be able to:

• Define the clinical question discussed during this presentation.
• Discuss the current available literature to support or refute current clinical practice.
• Express a conclusion and/or recommendation for addressing the clinical question.

Abstract Anthracyclines are a commonly used class of chemotherapy in various cancers, but their use is limited by dose-dependent cardiotoxicity. Dexrazoxane is currently the only drug approved for the prevention of anthracycline-induced cardiomyopathy. Although dexrazoxane’s indication is limited to women with metastatic breast cancer, its apparent benefits have led to use in other malignancies for patients requiring anthracycline therapy. There are concerns that dexrazoxane may reduce the oncologic efficacy of anthracyclines, and recent studies provide some insight into the benefits and risks. This presentation covers the use of dexrazoxane and its evidence in different adult malignancies.

Pharmacy Continuing Education Credits This program is sponsored by the University of Pittsburgh Center for Continuing Education in the Health Sciences. The University of Pittsburgh Center for Continuing Education in the Health Sciences is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a Provider of continuing pharmacy education. The assigned universal program number(s) is 0481-0000-19-128-H01-P. This module is a webcast of an ACPE approved live presentation. The minimum credit awarded for this module (1 contact hour) is determined by the length of the entire live presentation inclusive of the post-test.

Suggested Additional Reading:

1. Middleman E, Luce J, Frei E 3rd. Clinical trials with adriamycin. Cancer 1971 Oct;28(4):844-50.

2. Volkova M, Russell R 3rd. Anthracycline cardiotoxicity: prevalence, pathogenesis and treatment. Curr Cardiol Rev 2011;7(4):214–220.

3. Swain SM, Whaley FS, Ewer MS. Congestive heart failure in patients treated with doxorubicin: a retrospective analysis of three trials. Cancer 2003 Jun 1;97(11):2869-79.

4. Pasvolsky O, Morelli O, Rozovski U, et al. Anthracycline-Induced Cardiotoxicity in Acute Myeloid Leukemia Patients Who Undergo Allogeneic Hematopoietic Stem Cell Transplantation. Clin Lymphoma Myeloma Leuk 2019 Jul;19(7):e343-e348.

5. Smith LA, Cornelius VR, Plummer CJ, et al. Cardiotoxicity of anthracycline agents for the treatment of cancer: systematic review and meta-analysis of randomised controlled trials. BMC Cancer. 2010;10:337.

6. Minotti G, Menna P, Salvatorelli E, et al. Anthracyclines: molecular advances and pharmacologic developments in antitumor activity and cardiotoxicity. Pharmacol Rev 2004 Jun;56(2):185-229.

7. McGowan JV, Chung R, Maulik A, et al. Anthracycline Chemotherapy and Cardiotoxicity. Cardiovasc Drugs Ther. 2017;31(1):63–75.

8. Cvetković RS, Scott LJ. Dexrazoxane : a review of its use for cardioprotection during anthracycline chemotherapy. Drugs. 2005;65(7):1005-24.

9. Cardinale D, Colombo A, Bacchiani G, et al. Early detection of anthracycline cardiotoxicity and improvement with heart failure therapy. Circulation. 2015 Jun 2;131(22):1981-8.

10. Daunorubicin hydrochloride [package insert]. Eatontown, NJ: West-Ward Pharmaceuticals; 2018.

11. Doxorubicin hydrochloride [package insert]. Bridgewater, NJ: Amneal Biosciences LLC; 2017.

12. Anderlini P, Benjamin RS, Wong FC, et al. Idarubicin cardiotoxicity: a retrospective study in acute myeloid leukemia and myelodysplasia. J Clin Oncol. 1995 Nov;13(11):2827-34.

13. Epirubicin hydrochloride [package insert]. Parsippany, NJ: Actavis Pharma Inc.; 2016.

14. Mitoxantrone hydrochloride [package insert]. Fresenius Kabi USA, LLC; 2017

15. Armenian SH, Lacchetti C, Barac A, et al. Prevention and Monitoring of Cardiac Dysfunction in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. 2017 Mar 10;35(8):893-911.