Patients with heart failure should be managed with optimal therapy with diuretics such as furosemide 20–60 mg once daily, an ACE inhibitor, digoxin, and a small dose of a beta-blocker. If heart failure persists, spironolactone should be added to the regimen (see the chapter Heart Failure). Changes in dose schedules to weekly intravenous infusions rather than a larger dose every 3 weeks appears to afford some cardioprotection.
C. Research Implications
In the prevention of cardiotoxicity, the use of liposome-encapsulated anthracyclines appears to be controversial.Dexrazoxane is capable of accepting the iron from the anthracycline–iron complex that generates tissue-damaging hydroxyl radicals and provides some cardioprotection. However, this agent may increase the incidence of myelosuppression and has not been shown to increase disease-free survival. Its use is limited to oncologists.
Agents that require further clinical testing include coenzyme Q10, melatonin, probucol, beta-blockers, cal¬cium antagonists, and glutathione. A transgenic mouse overexpressing the human complementary DNA for multi¬ple drug resistance, driven by an alpha-cardiac myosin gene, has been developed. These transgenic mice appear to be resistant to anthracycline-mediated cardiac-myocyte dropout. Newer agents that can be of value to many patients who suffer from cancer worldwide are being researched and developed.

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