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Epirubicin Cardiotoxicity: An Analysis Of 469 Patients With Metastatic Breast Cancer.

M. Ryberg, D. Nielsen, T. Skovsgaard, J. Hansen, B. V. Jensen, P. Dombernowsky
Published 1998 · Medicine

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PURPOSE To evaluate the influence of cumulative dose, dose-intensity, single-dose level, and schedule of epirubicin on the risk of developing congestive heart failure (CHF) in patients with advanced breast cancer. PATIENTS AND METHODS Four hundred sixty-nine consecutive anthracyline-naive patients with metastatic breast cancer were included. Only patients with cardiac failure according to New York Heart Association (NYHA) function class II or more were recorded as having CHF. For each patient, the following were calculated: the cumulative dose of epirubicin, mean dose-intensity (cumulative dose of epirubicin/duration of treatment), and single-dose level (cumulative dose of epirubicin/number of injections). RESULTS Thirty-four patients (7.2%) developed CHF. The cumulative risk of cardiotoxicity was 4% at 900 mg/m2 and increased exponentially to 15% at 1,000 mg/m2. Irradiation against the mediastinum and thoracic spine increased the risk of CHF (P=.025), but dose-intensity, single-dose level, and schedule had no influence on the risk of developing CHF. Age, previous adjuvant irradiation (to the left or right hemithorax), and previous chemotherapy (cyclophosphamide, methotrexate, and fluorouracil [CMF]) were not risk factors. The median time to onset of CHF following the last dose of epirubicin was 57 days (range, 0 to 853). Among patients with CHF, 13 (38.2%) died of cardiac failure. The median survival time for all patients with CHF was 162 days (range, 0 to +1,957). Previous irradiation directly against the heart increased the risk of death due to cardiac failure and decreased the median survival time to 125 days (range, 0 to 336). CONCLUSION The present large retrospective study of 469 patients substantiates previous results concerning the cardiotoxicity of epirubicin. A significantly increasing risk of CHF in patients who receive cumulative doses greater than 950 mg/m2 was established. The future recommended maximum cumulative dose of epirubicin should be 900 mg/m2 in patients with metastatic breast cancer. Previous irradiation against the heart leads to an increased risk of developing CHF with an accelerated course to death, which indicates an additive cardiotoxic effect of irradiation and epirubicin.
This paper references
10.1097/00000421-198902000-00014
A Comparative Study of Doxorubicin and Epirubicin in Patients with Metastatic Breast Cancer
G. Hortobagyi (1989)
10.7326/0003-4819-91-5-710
Risk factors for doxorubicin-induced congestive heart failure.
D. V. Von Hoff (1979)
10.1016/S0140-6736(96)91721-3
Angiotensin-converting enzyme inhibitor for epirubicin-induced dilated cardiomyopathy
K. Hatake (1996)
10.1016/S0140-6736(96)90469-9
Treatment with angiotensin-converting-enzyme inhibitor for epirubicin-induced dilated cardiomyopathy
B. V. Jensen (1996)
10.1200/JCO.1989.7.7.947
Cardiac morphologic and functional changes induced by epirubicin chemotherapy.
M. Dardir (1989)
10.1002/1097-0142(19890101)63:1<37::AID-CNCR2820630106>3.0.CO;2-Z
Decreased cardiac toxicity of doxorubicin administered by continuous intravenous infusion in combination chemotherapy for metastatic breast carcinoma
G. Hortobagyi (1989)
Adriamycin given as a weekly schedule without a loading course: clinically effective with reduced incidence of cardiotoxicity.
R. Chlebowski (1980)
Cardiotoxicity of epirubicin and doxorubicin: assessment by endomyocardial biopsy.
F. Torti (1986)
10.1200/JCO.1990.8.11.1806
Epirubicin cardiotoxicity: a study of 135 patients with advanced breast cancer.
D. Nielsen (1990)
10.2165/00003495-199345050-00011
Epirubicin. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic use in cancer chemotherapy.
G. Plosker (1993)
10.7326/0003-4819-96-2-133
Reduction of doxorubicin cardiotoxicity by prolonged continuous intravenous infusion.
S. Legha (1982)
Adriamycin cardiotoxicity: a survey of 1273 patients.
C. Praga (1979)
Epirubicin high-dose therapy in advanced breast cancer: preliminary clinical data. Epirubicin as a single agent in breast cancer.
B. Neri (1989)
10.1200/JCO.1985.3.6.818
A prospective randomized comparison of epirubicin and doxorubicin in patients with advanced breast cancer.
K. K. Jain (1985)
10.1200/JCO.1991.9.12.2148
A randomized comparison of single-agent doxorubicin and epirubicin as first-line cytotoxic therapy in advanced breast cancer.
D. Perez (1991)
10.1093/OXFORDJOURNALS.ANNONC.A057748
Epirubicin or epirubicin and vindesine in advanced breast cancer. A phase III study.
D. Nielsen (1990)
10.1200/JCO.1986.4.3.425
Epirubicin: a review of the pharmacology, clinical activity, and adverse effects of an adriamycin analogue.
R. J. Cersosimo (1986)
Phase II study of doxorubicin versus epirubicin in advanced breast cancer.
C. Brambilla (1986)
10.1002/1097-0142(19921201)70:11<2637::AID-CNCR2820701112>3.0.CO;2-P
Outcome of clinical congestive heart failure induced by anthracycline chemotherapy
J. Moreb (1992)
10.2307/2531305
Cancer Clinical Trials: Methods and Practice.
L. Freedman (1985)
10.1002/1097-0142(19850915)56:6<1361::AID-CNCR2820560624>3.0.CO;2-S
Doxorubicin‐induced congestive heart failure in adults
M. M. Haq (1985)
10.1002/1097-0142(19800901)46:5<1109::AID-CNCR2820460506>3.0.CO;2-B
Anthracycline cardiotoxicity: Clinical and pathologic outcomes assessed by radionuclide ejection fraction
J. Ritchie (1980)
10.1001/JAMA.1979.03300190015015
Complete responders to chemotherapy in metastatic breast cancer. Characterization and analysis.
D. Decker (1979)
10.1097/00000478-197701010-00002
Adriamycin cardiotoxicity: Endomyocardial biopsy evidence of enhancement by irradiation
M. Billingham (1977)



This paper is referenced by
10.2146/AJHP060609
Antiemetic care for patients with breast cancer: focus on drug interactions and safety concerns.
A. Georgy (2007)
10.1053/J.SEMINONCOL.2005.11.001
Anticancer agents and cardiotoxicity.
R. Ng (2006)
10.1007/0-387-31056-8_2
Principles of chemotherapy
G. Dy (2006)
10.1200/JCO.2011.35.5008
Cardiotoxicity in patients treated with bevacizumab is potentially reversible.
E. Hawkes (2011)
10.1023/A:1008390203340
Cardiac effects of high-dose epirubicin and cyclophosphamide in women with poor prognosis breast cancer.
R. Basser (1999)
10.1093/jnci/djn206
New insight into epirubicin cardiac toxicity: competing risks analysis of 1097 breast cancer patients.
M. Ryberg (2008)
10.1109/IEMBS.2000.901423
Deep inspiration breath hold to reduce irradiated heart volume in breast cancer patients
K. Sixel (2000)
10.1200/JCO.2005.07.032
Significantly higher pathologic complete remission rate after neoadjuvant therapy with trastuzumab, paclitaxel, and epirubicin chemotherapy: results of a randomized trial in human epidermal growth factor receptor 2-positive operable breast cancer.
A. Buzdar (2005)
10.1007/S12094-008-0150-8
Cardiac toxicity: old and new issues in anti-cancer drugs
M. Sereno (2008)
10.1016/j.pharmthera.2009.10.002
Anticancer drugs and cardiotoxicity: Insights and perspectives in the era of targeted therapy.
E. Raschi (2010)
10.1046/J.1365-2125.2002.01579.X
Pharmacokinetics and pharmacodynamics of combination chemotherapy with paclitaxel and epirubicin in breast cancer patients.
R. Danesi (2002)
10.1007/s12032-016-0801-5
Cancer treatment-related cardiac toxicity: prevention, assessment and management
Ibrahim Fanous (2016)
10.5604/20828691.1189759
Early diagnostics and prevention of anthracycline-induced cardiomyopathy – the role of cardiologist
I. Chazova (2015)
10.1200/JCO.2001.19.5.1444
Reduced cardiotoxicity and preserved antitumor efficacy of liposome-encapsulated doxorubicin and cyclophosphamide compared with conventional doxorubicin and cyclophosphamide in a randomized, multicenter trial of metastatic breast cancer.
G. Batist (2001)
10.1634/THEONCOLOGIST.7-1-65
The cardiotoxic potential of the 5-HT(3) receptor antagonist antiemetics: is there cause for concern?
D. Keefe (2002)
10.1080/02841860601156165
Anthracycline-induced chronic cardiotoxicity and heart failure
J. M. Appel (2007)
10.7150/ijms.3827
Cancer Survivors in the United States: A Review of the Literature and a Call to Action
M. Valdivieso (2012)
10.1007/S12558-011-0190-9
L’évaluation prospective de la fonction cardiaque chez les patientes traitées pour cancer du sein par anthtracyclines en adjuvant: résultats préliminaires
Oumaima Mesbahi (2012)
10.1634/THEONCOLOGIST.10-10-780
Adjuvant chemotherapy for early breast cancer: optimal use of epirubicin.
Stefan Glück (2005)
10.1038/s41467-018-04763-y
Near infrared fluorescent peptide nanoparticles for enhancing esophageal cancer therapeutic efficacy
Z. Fan (2018)
10.1136/postgradmedj-2011-130698
Reversible heart failure: toxins, tachycardiomyopathy and mitochondrial abnormalities
P. Morris (2012)
10.1016/j.cardfail.2013.12.018
Cancer therapy-induced left ventricular dysfunction: interventions and prognosis.
Akanksha Thakur (2014)
10.1111/J.1527-5299.2007.07122.X
Altered left ventricular diastolic performance in oncologic patients treated with epirubicin.
D. Radulescu (2007)
10.1016/S0960-9776(02)00180-7
Combined epirubicin and vinorelbine as first-line therapy in metastatic breast cancer: a pilot study performed by the Danish Breast Cancer Cooperative Group.
B. Ejlertsen (2003)
10.1155/2020/5706561
The Predictive Value of 2D Myocardial Strain for Epirubicin-Induced Cardiotoxicity
Ichrak Ben Abdallah (2020)
10.2459/JCM.0000000000000375
Cardiotoxicity from anthracycline and cardioprotection in paediatric cancer patients
P. Bassareo (2016)
10.1634/THEONCOLOGIST.7-5-424
5-HT(3)-receptor antagonists for the treatment of nausea and vomiting: a reappraisal of their side-effect profile.
S. Goodin (2002)
10.1016/j.ijrobp.2017.06.005
Concurrent Neoadjuvant Chemotherapy and Radiation Therapy in Locally Advanced Breast Cancer.
M. Brackstone (2017)
10.3389/fonc.2014.00346
Cardiovascular Toxicities from Systemic Breast Cancer Therapy
S. Guo (2014)
10.1007/s11912-014-0396-y
Cardiotoxicity of Antineoplastic Agents: What Is the Present and Future Role for Imaging?
T. Markman (2014)
10.1007/s10554-009-9518-2
Systolic versus diastolic cardiac function variables during epirubicin treatment for breast cancer
J. M. Appel (2009)
10.1007/s00508-010-1363-8
Komorbiditätsorientierte Onkologie – ein Überblick
R. Simanek (2010)
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