Researchers are studying to see if they can determine sooner whether the drug doxorubin (Adriamycin?/Doxil?) ? often called the red stuff by patients because of its ruby red color ? might cause long-term damage to breast cancer patients who use it.
While doxorubucin has proven effective in treating breast cancer, it has been shown to cause heart damage in a small percentage of patients many years after completing treatment, said Charles Shapiro, MD, director of breast medical oncology and leader of the breast cancer research program at the Ohio State University Comprehensive Cancer Center ? Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC-James).
One of the best drugs to treat in breast cancer
Usually that heart damage is detected by the use of echocardiograms. ?By the time decreased heart function is detected during an echocardiogram, it?s already too late. The damage is done,? said Shapiro. ?Doxorubicin is one of the best drugs in breast cancer. But we?ve got to contend with this small, increased risk of heart damage. For those who develop problems, it?s serious.?
As part of the clinical trial, researchers are using high-definition cardiac MRIs along with frequent blood tests on patients who are using this drug, to see if they can spot heart damage much earlier in the process ? when it is most likely to be treated most effectively, said Maryam Lustberg,MD, an Ohio State University Comprehensive Cancer Center/James breast medical oncologist also involved in the clinical trial.
The researchers are looking for damage at the cellular level, in what?s known as endothelial precursor cells, which are the very first changes in tissue that indicate damage to the heart, said Lustberg. ?With these sensitive tests, we can see the swelling or edema occurring at very early stages in addition to changes to the heart valves that we might not otherwise see,? said Lustberg. ?The purpose of this study is to find early markers of heart toxicity so that we can intervene earlier.?
This particular chemotherapy is generally safe, Shapiro said, and only a small percentage of women may be at risk for heart damage. ?But knowing more about which women are at risk, and when reversible damage occurs, could help doctors treat women more effectively and ideally prevent irreversible injury,? said Dr. Subha Raman, a cardiologist and professor of cardiovascular medicine at Ohio State?s Medical Center.
?This study will help determine if there is a better way to identify early effects chemotherapy on the heart for future patients,? said Raman, who is also the medical director of cardiac MRI and CT.
Advances in treatment
The fact that this study is taking place at all is a testament to advances in the treatment of breast cancer, said Shapiro. Just a generation ago, doctors took a ?kill the cancer first and foremost? approach to treating the disease. Today, survival rates have grown so much, that doctors are now treating patients with their long-term future in mind, he said.
Not enough just to try and cure cancer
?Because women are living longer than ever after being diagnosed with breast cancer, it?s not enough just to try and cure the cancer,? said Shapiro. ?Now we want to make sure life after cancer is safe and enjoyable.? The clinical trial is open to men and women with localized breast cancer, stages I to III, who will be receiving a class of chemotherapy treatments known as anthracyclines during their course of treatment at the Stefanie Spielman Comprehensive Breast Center at Ohio State.
Each participant will receive three free cardiac magnetic resonance scans during their treatment: before treatment starts, after one cycle of chemotherapy and at the end of treatment.
Other Ohio State heart researchers involved in the study are Dr. Philip Binkley, and Hiranmoy Das.
This research is supported by the Ohio State Center for Clinical and Translational Science, a collaboration of scientists and clinicians from seven OSU Health Sciences Colleges, OSU Medical Center and Nationwide Children’s Hospital.
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