Enalapril to prevent cardiac function decline in long-term survivors of pediatric cancer exposed to anthracyclines Journal Article
| Authors: | Silber, J. H.; Cnaan, A.; Clark, B. J.; Paridon, S. M.; Chin, A. J.; Rychik, J.; Hogarty, A. N.; Cohen, M. I.; Barber, G.; Rutkowski, M.; Kimball, T. R.; Delaat, C.; Steinherz, L. J.; Zhao, H. |
| Article Title: | Enalapril to prevent cardiac function decline in long-term survivors of pediatric cancer exposed to anthracyclines |
| Abstract: | Purpose: To determine whether an angiotensin-converting enzyme (ACE) inhibitor, enalapril, prevents cardiac function deterioration (defined using maximal cardiac index [MCI] on exercise testing or increase in left ventricular end-systolic wall stress [LVESWS]) in long-term survivors of pediatric cancer. Patients and Methods: This was a randomized, double-blind, controlled clinical trial comparing enalapril to placebo in 135 long-term survivors of pediatric cancer who had at least one cardiac abnormality identified at any time after anthracycline exposure. Results: There was no difference in the rate of change in MCI per year between enalapril and placebo groups (0.30 v 0.18 L/min/m 2; P = .55). However, during the first year of treatment, the rate of change in LVESWS was greater in the enalapril group than in the placebo group (-8.59 v 1.85 g/cm2; P = .033) and this difference was maintained over the study period, resulting in a 9% reduction in estimated LVESWS by year 5 in the enalapril group. Six of seven patients removed from random assignment to treatment because of cardiac deterioration were initially treated with placebo (P = .11), and one has died as a result of heart failure. Side effects from enalapril included dizziness or hypotension (22% v 3% in the placebo group; P = .0003) and fatigue (10% v 0%; P = .013). Conclusion: Enalapril treatment did not influence exercise performance, but did reduce LVESWS in the first year; this reduction was maintained over the study period. Any theoretical benefits of LVESWS reduction in this anthracycline-exposed population must be weighed against potential side effects from ACE inhibitors when making treatment decisions. © 2004 by American Society of Clinical Oncology. |
| Keywords: | adolescent; adult; cancer survival; child; controlled study; preschool child; treatment outcome; child, preschool; survival rate; major clinical study; clinical trial; disease course; fatigue; placebo; pathophysiology; comparative study; follow up; follow-up studies; neoplasm; neoplasms; linear models; controlled clinical trial; randomized controlled trial; patient monitoring; drug effect; pathology; childhood cancer; survivor; risk assessment; survivors; dizziness; hypotension; hospitalization; severity of illness index; probability; disease progression; heart failure; chemically induced disorder; reference values; anthracycline derivative; anthracycline; double blind procedure; double-blind method; anthracyclines; exercise test; exercise tolerance; statistical model; congestive heart failure; heart protection; heart index; drug exposure; heart function; reference value; enalapril; heart function test; heart left ventricle enddiastolic pressure; general condition deterioration; heart failure, congestive; heart function tests; humans; prognosis; human; male; female; priority journal; article |
| Journal Title: | Journal of Clinical Oncology |
| Volume: | 22 |
| Issue: | 5 |
| ISSN: | 0732-183X |
| Publisher: | American Society of Clinical Oncology |
| Date Published: | 2004-03-01 |
| Start Page: | 820 |
| End Page: | 828 |
| Language: | English |
| DOI: | 10.1200/jco.2004.06.022 |
| PROVIDER: | scopus |
| PUBMED: | 14990637 |
| DOI/URL: | |
| Notes: | J. Clin. Oncol. -- Cited By (since 1996):97 -- Export Date: 16 June 2014 -- CODEN: JCOND -- Source: Scopus |
