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Late Cardiac Effects Of Chemotherapy In Breast Cancer Survivors Treated With Adjuvant Doxorubicin: 10-year Follow-up

G. Murtagh, T. Lyons, E. O’Connell, J. Ballot, L. Geraghty, D. Fennelly, G. Gullo, M. Ledwidge, J. Crown, J. Gallagher, C. Watson, K. McDonald, J. Walshe
Published 2016 · Medicine

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Doxorubicin (Dox), a mainstay of adjuvant breast cancer treatment, is associated with cardiac toxicity in the form of left ventricular dysfunction (LVD), LV diastolic dysfunction, or LV systolic dysfunction. Study objectives were to evaluate the prevalence of LVD in long-term breast cancer survivors treated with Dox and determine if brain-type natriuretic peptide (BNP) may help identify patients at risk for LVD. Patients who participated in prospective clinical trials of adjuvant Dox-based chemotherapy for breast cancer with a baseline left ventricular (LV) ejection fraction evaluation from 1999 to 2006 were retrospectively identified from the St Vincent’s University Hospital database. Patients were invited to undergo transthoracic echocardiography, BNP analysis, and cardiovascular (CV) risk factor assessment. LVDD was defined as left atrial volume index >34 mL/m2 and/or lateral wall E prime <10 m/s, and LVSD as LVEF <50 %. Of 212 patients identified, 154 participated, 19 patients had died (no cardiac deaths), and 39 declined. Mean age was 60.7 [55:67] years. A majority of the patients (128, 83 %) had low CV risk (0/1 risk factors), 21 (13.6 %) had 2 RFs, and 5 (3.2 %) ≥3 RFs. BMI was 27.2 ± 4.9 kg/m2. Median Dox dose was 240 mg/m2 [225–298]; 92 patients (59.7 %) received ≤240 mg/m2 and 62 (40.3 %) > 240 mg/m2. Baseline LVEF was 68.2 ± 8 %. At follow-up of 10.8 ± 2.2 years, LVEF was 64.4 ± 6 %. Three (1.9 %) subjects had LVEF <50 % and one (0.7 %) had LVDD. Dox >240 mg/m2 was associated with any LVEF drop. BNP levels at follow-up were 20.3 pg/ml [9.9–36.5] and 21.1 pg/ml [9.8–37.7] in those without LVD and 61.5 pg/ml [50–68.4] in those with LVD (p = 0.04). Long-term prospective data describing the impact of Dox on cardiotoxicity are sparse. At over 10 years of follow-up, decreases in LVEF are common, and dose related, but LVD as defined is infrequent (2.6 %). Monitoring with BNP for subclinical LVD needs further evaluation.
This paper references
M. G (2000)
Chronic progressive cardiac dysfunction years after doxorubicin therapy for childhood acute lymphoblastic leukemia.
S. Lipshultz (2005)
Dose-effect and structure-function relationships in doxorubicin cardiomyopathy.
M. Bristow (1981)
Congestive heart failure and left ventricular dysfunction complicating doxorubicin therapy. Seven-year experience using serial radionuclide angiocardiography.
R. G. Schwartz (1987)
Myocardial dysfunction late after low-dose anthracycline treatment in asymptomatic pediatric patients.
J. Ganame (2007)
Left ventricular function assessed by two-dimensional speckle tracking echocardiography in long-term survivors of Hodgkin's lymphoma treated by mediastinal radiotherapy with or without anthracycline therapy.
H. Tsai (2011)
Seven-Year Follow-Up Assessment of Cardiac Function in NSABP B-31, a Randomized Trial Comparing Doxorubicin and Cyclophosphamide Followed by Paclitaxel (ACP) With ACP Plus Trastuzumab As Adjuvant Therapy for Patients With Node-Positive, Human Epidermal Growth Factor Receptor 2–Positive Breast Cancer
M. Zibelman (2013)
Use of myocardial strain imaging by echocardiography for the early detection of cardiotoxicity in patients during and after cancer chemotherapy: a systematic review.
P. Thavendiranathan (2014)
Cardiotoxicity of anthracycline agents for the treatment of cancer: Systematic review and meta-analysis of randomised controlled trials
L. Smith (2010)
Cardiovascular management of cancer patients with chemotherapy-associated left ventricular systolic dysfunction in real-world clinical practice.
Michael Ammon (2013)
Seven-year follow-up assessment of cardiac function in NSABP B-31, a randomized trial comparing doxorubicin and cyclophosphamide followed by paclitaxel (ACP) with ACP plus trastuzumab as adjuvant therapy for patients with node-positive, human epidermal growth factor receptor 2-positive breast cancer
Edward H. Romond (2012)
American Society of Clinical Oncology clinical evidence review on the ongoing care of adult cancer survivors: cardiac and pulmonary late effects.
J. Carver (2007)
Topoisomerase IIbeta mediated DNA double-strand breaks: implications in doxorubicin cardiotoxicity and prevention by dexrazoxane.
Y. Lyu (2007)
Routine cardiac evaluation in patients with early-stage breast cancer before adjuvant chemotherapy.
Alwin Jeyakumar (2012)
Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.
J. Plana (2014)
Left ventricular dysfunction in patients receiving cardiotoxic cancer therapies are clinicians responding optimally?
Geoffrey J. Yoon (2010)
Doxorubicin vs epirubicin, report of a second-line randomized phase II/III study in advanced breast cancer. EORTC Breast Cancer Cooperative Group.
M. Bontenbal (1998)
Congestive heart failure in patients treated with doxorubicin
S. Swain (2003)
Cardiovascular disease: cause of morbidity and mortality in adult survivors of childhood cancers.
M. Chen (2011)
Subclinical anthracycline- and trastuzumab-induced cardiotoxicity in the long-term follow-up of asymptomatic breast cancer survivors: a speckle tracking echocardiographic study
E. Ho (2010)
Cardiac Toxicity in Breast Cancer Survivors: Review of Potential Cardiac Problems
B. Bird (2008)
Oxidative Damage of Cardiomyocytes Is Limited by Extracellular Regulated Kinases 1/2-mediated Induction of Cyclooxygenase-2*
S. Adderley (1999)
Cardiac effects of adjuvant doxorubicin and radiation therapy in breast cancer patients.
C. Shapiro (1998)
Risk factors for doxorubicin-induced congestive heart failure.
D. V. Von Hoff (1979)
Cardiac outcomes in a cohort of adult survivors of childhood and adolescent cancer: retrospective analysis of the Childhood Cancer Survivor Study cohort
J. Stockman (2011)
Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures.
S. Nagueh (1997)
Type II chemotherapy-related cardiac dysfunction: time to recognize a new entity.
M. Ewer (2005)
Screening adult survivors of childhood cancer for cardiomyopathy: comparison of echocardiography and cardiac magnetic resonance imaging.
G. Armstrong (2012)
Daunomycin-induced cardiotoxicity in children and adults. A review of 110 cases.
D. V. Von Hoff (1977)
Prognostic Value of Troponin I in Cardiac Risk Stratification of Cancer Patients Undergoing High-Dose Chemotherapy
D. Cardinale (2004)
Assessment of Echocardiography and Biomarkers for the Extended Prediction of Cardiotoxicity in Patients Treated With Anthracyclines, Taxanes, and Trastuzumab
Heloisa Sawaya (2012)
Brain Natriuretic Peptide Is a Predictor of Anthracycline-Induced Cardiotoxicity
H. Okumura (2000)
Reproducibility of echocardiographic techniques for sequential assessment of left ventricular ejection fraction and volumes: application to patients undergoing cancer chemotherapy.
P. Thavendiranathan (2013)

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M. Eftekhari (2017)
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N. Shelburne (2019)
A Review on the Effect of Traditional Chinese Medicine Against Anthracycline-Induced Cardiac Toxicity
X. Yang (2018)
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R. Haidinger (2019)
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T. Zhan (2019)
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Association between FDG uptake in the right ventricular myocardium and cancer therapy-induced cardiotoxicity
J. Kim (2019)
Long-term outcome of cardiac function in a population-based cohort of breast cancer survivors: A cross-sectional study.
L. Boerman (2017)
Cardiovascular disease risk among breast cancer survivors: an evolutionary concept analysis
Jacqueline B. Vo (2017)
Cardioprotective effect of Platycodon grandiflorum in patients with early breast cancer receiving anthracycline-based chemotherapy: study protocol for a randomized controlled trial
W. Hao (2017)
Predictive value of soluble ST-2 for changes of cardiac function and structure in breast cancer patients receiving chemotherapy
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Adjuvant trastuzumab: a 10-year overview of its benefit
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Cardiorespiratory fitness and adiposity in breast cancer survivors: is meeting current physical activity recommendations really enough?
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