Genetic Differences May Explain Why Childhood Cancer Survivors Are More Likely to Experience Heart Problems Later in Life

According to a new study, variations in genes that metabolize (break down) certain types of anticancer drugs may explain why some survivors of childhood cancer experience heart problems, such as congestive heart failure, later in life.

Anthracyclines are a class of anticancer drugs often used to treat many types of childhood cancer and include daunorubicin (Daunomycin, Cerubidine), doxorubicin (Adriamycin, Rubex), epirubicin (Ellence), idarubicin (Idamycin), and mitoxantrone (Novantrone). Although these drugs have greatly improved survival rates for children with cancer, they may cause damage to the heart that may not appear until 10 or 15 years after treatment. This study was done so that doctors could begin to understand why some survivors are more likely to have heart problems than others.

In this study, researchers identified 47 patients with congestive heart failure and selected 195 patients without heart problems as a comparison or control group from 5,739 patients enrolled in the Childhood Cancer Survivor Study. The researchers collected DNA samples from the patients and studied the genes that are thought to be the cause of anthracycline-related heart damage. They found several specific genetic variations that appeared to be risk factors for heart disease in these patients, and these variations may explain why some childhood cancer survivors are more likely to have heart problems later in life.

What This Means For Patients

"We can't say based on this study that we're ready to start testing patients for these variations. We need to look at more patients and look for additional genetic changes that may be important," said Richard Aplenc, MD, Assistant Professor of Pediatrics at the University of Pennsylvania School of Medicine, Attending Physician at Children's Hospital of Philadelphia, and the study's lead author. "However, our hope is that one day we might use this type of information to guide treatment decisions and determine which cancer survivors should be more closely monitored for heart problems in the years following treatment."