By: Zeinab Al kasaby  Zalat^{* 1}, Hosny A. Elewa²,Mohamed Abdel-Latif^{3 ,} Mohamed A. Alm El-Din⁴, Neeven A. Kohaf ⁵

1. Assoc. Professor and Head of Clinical Pharmacy Department, Faculty of Pharmacy, Al-Azhar University, Cairo, Egypt. (Pharm.D., Ph.D.) (zeinabalkasaby.pharmg@azhar.edu.eg)
2. Assoc. professor and Head of Pharmacy Practice Department, Faculty of Pharmacy, Horus University, Dominate City, Egypt. (Pharm.D, Ph.D.)
3. Professor and Head of Clinical Pharmacy Department, Faculty of Pharmacy, Assiut University, Assiut, Egypt. (Ph.D.)
4. Assoc. Professor, Department of Clinical Oncology, Faculty of Medicine, Tanta University, Tanta, Egypt. (MD)
5. Master degree in pharmaceutical sciences, Faculty of Pharmacy, Al-Azhar University, Cairo, Egypt. (M.Sc.)

Abstract

Aim: Anthracycline-induced cardiotoxicity is the most common constraint of its use in the treatment of various types of cancer. This study aimed to investigate the benefits of the addition of the l-carnitine / silymarin to anthracycline chemotherapy in patients with breast cancer. Methods: 83 patients were recruited from Clinical Oncology Department, Tanta University, Egypt, then prospectively randomized to receive their anthracycline-containing therapeutic regimen, control group (n=33), or anthracycline plus l-carnitine, l-carnitine group (n=25), or anthracycline plus silymarin, silymarin group (n= 25). Blood samples were collected at the beginning and after 6 months to measure LDH, CK-MB, cTn I, Anticardiolipin IgG, Fe, ferritin, and TIBC and % of saturation. % EF was documented. Data were statistically analyzed by ANOVA and paired t-test. P <0.05 was statistically significant. Results: The addition of l-carnitine to anthracycline chemotherapy has a significantly improved EF% (P=0.003), Anticardiolipin IgG (P=0.001), ferritin (P=0.001), and TIBC (P=0.011). The supplementation with silymarin to anthracycline chemotherapy had a statistically significant decrease in Anticardiolipin IgG (P=0.000), iron (P=0.001), ferritin (P= 0.001), TIBC (P=0.007), and % saturation (P=0.001). Silymarin group showed a significant decrease in iron profile compared to the l-carnitine group. Conclusion: The co-administration of l-carnitine or silymarin with anthracycline chemotherapy represents a new therapeutic strategy for better control of anthracycline-induced cardiotoxicity. Silymarin resulted in more beneficial effects on the iron profile compared to l-carnitine with anthracycline or anthracycline chemotherapy alone.

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