Anthracyclines are anti-cancer drugs that are used in the treatment of different types of childhood cancer. An important adverse effect of anthracyclines is damage to the heart that can lead to asymptomatic (without complaints) or symptomatic (with complaints) cardiac problems during and after cancer treatment. There are several drugs available to treat other types of cardiac problems in adults, but it is not known if these drugs are beneficial in treating cardiac problems caused by anthracyclines in childhood cancer patients and survivors. If a physician is confronted with a childhood cancer patient or survivor with anthracycline-induced cardiac problems, he or she should be able to make an informed decision to treat this patient based on high-quality evidence about the beneficial and adverse effects of the treatment options. We searched for and summarised studies that evaluated drugs for treating anthracycline-induced cardiac problems in childhood cancer patients and survivors.
We identified two randomised studies evaluating two different drugs in two different types of patients. One of these drugs, an ACE-inhibitor (enalapril), had a short-term beneficial effect on heart function in survivors of childhood cancer with asymptomatic cardiac problems caused by anthracyclines compared with placebo. However, the drug had no significant beneficial effect on other important outcomes and was associated with side effects such as dizziness and fatigue. This study was of reasonable/good quality. The other study was of low quality and found no effect of a short treatment with phosphocreatine in childhood leukaemia patients with symptomatic or asymptomatic cardiac problems compared with a control treatment with vitamin C, ATP, vitamin E, and oral coenzyme Q10.
No definitive conclusions can be made about treatment options for anthracycline-induced cardiac problems in childhood cancer patients and survivors. High-quality studies are necessary to show if there are drugs that improve heart function in these patients.