From the Guidelines
Doxorubicin-induced cardiotoxicity can be predicted by the lymphocyte-to-monocyte ratio (LMR), with lower LMR values associated with higher risk of cardiac complications, and clinicians should consider monitoring LMR in patients receiving doxorubicin, particularly when cumulative doses exceed 250-300 mg/m². The mechanism behind LMR's predictive value likely involves the inflammatory process, as monocytes contribute to cardiac damage through inflammation and fibrosis, while lymphocytes play a protective role in cardiac remodeling 1. Doxorubicin, an anthracycline chemotherapeutic agent, can cause dose-dependent cardiotoxicity that may manifest as decreased left ventricular ejection fraction, heart failure, arrhythmias, or cardiomyopathy. The risk of clinical cardiotoxicity increases with a cumulative dose, with studies evaluating cumulative probability of doxorubicin-induced heart failure finding rates in the range of 3%–5% with 400 mg/m2, 7%–26% at 550 mg/m2, and 18%–48% at 700 mg/m2 1.
Some key points to consider in the management of doxorubicin-induced cardiotoxicity include:
- Monitoring cardiac function in all patients after treatment with anthracyclines to identify asymptomatic patients who are experiencing increased cardiac damage 1
- Using cardiac biomarkers such as troponin and BNP to identify patients at risk for long-term cardiotoxicity 1
- Considering cardioprotective strategies such as dexrazoxane administration, liposomal doxorubicin formulations, or concurrent beta-blocker or ACE inhibitor therapy for patients with low LMR values who require doxorubicin treatment 1
- Recognizing that individual susceptibility to anthracycline cardiotoxicity is likely due to genetic variants in genes that regulate anthracycline cardiotoxicity, and that other risk factors for anthracycline toxicity include cumulative dose, intravenous bolus administration, higher single doses, history of prior irradiation, use of concomitant agents known to have cardiotoxicity, female gender, underlying CV disease, age (young and elderly), delayed diagnosis, and increase in cardiac biomarkers during and after administration 1.
In terms of specific management strategies, for patients with low pre-treatment LMR, more frequent cardiac monitoring may be warranted, including baseline and follow-up echocardiograms, cardiac biomarkers like troponin and BNP, and possibly cardiac MRI in high-risk cases. Additionally, cardioprotective strategies such as dexrazoxane administration, liposomal doxorubicin formulations, or concurrent beta-blocker or ACE inhibitor therapy might be considered earlier for patients with low LMR values who require doxorubicin treatment 1.
Overall, the lymphocyte-to-monocyte ratio (LMR) may serve as a useful biomarker for predicting doxorubicin-induced cardiotoxicity, and clinicians should consider monitoring LMR in patients receiving doxorubicin, particularly when cumulative doses exceed 250-300 mg/m². By recognizing the risk factors for anthracycline cardiotoxicity and using cardioprotective strategies, clinicians can help to minimize the risk of cardiac complications in patients receiving doxorubicin treatment.
From the Research
Lymphocyte Monocyte Ratio and Cardiotoxicity of Doxorubicin
- The provided studies do not directly address the relationship between lymphocyte monocyte ratio and cardiotoxicity of doxorubicin 2, 3, 4, 5, 6.
- However, the studies discuss the mechanisms and management of doxorubicin-induced cardiotoxicity, including the role of oxidative stress, free radical generation, apoptosis, and mitochondrial damage 2, 3, 4, 5.
- Some studies suggest that serial cardiac function monitoring with equilibrium radionuclide angiocardiography can help prevent congestive heart failure in patients receiving doxorubicin therapy 6.
- The role of Sirtuin 1 (SIRT1) in protecting against doxorubicin-induced cardiotoxicity is also discussed, with potential therapeutic strategies involving the activation of SIRT1 2.
- Overall, while the provided studies do not specifically address the lymphocyte monocyte ratio, they provide insight into the mechanisms and management of doxorubicin-induced cardiotoxicity, which may be relevant to understanding the relationship between lymphocyte monocyte ratio and cardiotoxicity 2, 3, 4, 5, 6.
Key Findings
- Doxorubicin-induced cardiotoxicity is a significant concern in cancer treatment, with mechanisms involving oxidative stress, free radical generation, and apoptosis 3, 5.
- Serial cardiac function monitoring can help prevent congestive heart failure in patients receiving doxorubicin therapy 6.
- SIRT1 may play a protective role against doxorubicin-induced cardiotoxicity, with potential therapeutic strategies involving its activation 2.
- Further research is needed to understand the relationship between lymphocyte monocyte ratio and cardiotoxicity of doxorubicin, as the provided studies do not directly address this topic 2, 3, 4, 5, 6.