The red devil revisited.
نویسنده
چکیده
When I went to medical school, I was taught that conceptually, the toxicity of doxorubicin and anthracyclines in general could be compared with that of acetaminophen, such that as long as I operated within “the safe dose,” patients with cancer would derive only benefits, not toxicity. I do not believe that my teachers are to be blamed for this thinking. If we take a look at the original von Hoff curve, published in 1979, although there is a continuum of increasing probability of congestive heart failure, the slope of the curve remained relatively flat until the cumulative dose exceeded 550 mg/m. Von Hoff et al. (1) reported an overall incidence of heart failure of 2.2%. With the concern that this incidence was not an accurate reflection of the real severity of this adverse event, further work was done by Swain et al. (2). They indeed found a higher overall incidence of heart failure of 5.1%. The estimated cumulative percent of patients was 5% at a cumulative dose of 400 mg/m, rising more dramatically to 26% at a dose of 550mg/m. In the curve redrawn by those investigators, the slope of the curve appeared to change at 450 mg/m, with the majority of events occurring at cumulative doses exceeding 500 mg/m.
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عنوان ژورنال:
- JACC. Cardiovascular imaging
دوره 6 8 شماره
صفحات -
تاریخ انتشار 2013