Letter by Lipshultz Regarding Article, “Anthracycline Cardiotoxicity: Worrisome Enough to Have You Quaking?”
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To the Editor:
The important editorial by Bernstein1 in the January 19, 2018, issue of Circulation Research on preclinical models of anthracycline cardiotoxicity and cardioprotection, contains errors that should be corrected, lest they adversely affect clinical care.
Dr Bernstein states that “Current prevention strategies involve limiting total exposure to anthracycline to the lowest possible dose and use of the iron chelator dexrazoxane. However, as a result of the potential for an increased risk of secondary malignancies, the European Medicines Agency has limited the indication for dexrazoxane to adult patients with advanced disease and contraindicated its use in children. Thus, the search for a more effective preventive therapeutic is critical, and the contribution of Gupta et al suggests a new pathway that is worth investigating.”
Dr Bernstein is of course correct in encouraging the use of preventive measures to reduce anthracycline-induced cardiotoxicity. Dexrazoxane provides substantial protection against anthracycline cardiotoxicity without reducing its oncological efficacy, even allowing safer anthracycline dose escalation.2,3 He is also correct in saying that dexrazoxane is approved for women with breast cancer. However, in 2014, the US Food and Drug Administration granted dexrazoxane pediatric orphan drug status,4 and dexrazoxane has never been contraindicated in the pediatric population in the United States.4 Further, in 2017, the European Medicines Agency …