Cardiac assessment of early breast cancer patients 18 years after treatment with cyclophosphamide-, methotrexate-, fluorouracil- or epirubicin-based chemotherapy.
Background Epirubicin-based chemotherapy improves the outcome of early breast cancer (BC) patients. However, cardiotoxicity remains an important side effect. Methods We re-consented node-positive BC patients enrolled in a phase III trial between 1988 and 1996 which compared six cycles of oral cyclop...
| Publicado en: | European Journal of Cancer Vol. 51; no. 17; pp. 2517 - 2525 |
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| Autores principales: | , , , , , , , , , , , , , , , |
| Formato: | clinical trial research Journal Article |
| Publicado: |
Pergamon Press - An Imprint of Elsevier Science
Nov2015
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=112665765&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 112665765 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 09598049 1VW jtl: European Journal of Cancer issn: 09598049 maglogo: N pubinfo: dt: Nov2015 vid: 51 iid: 17 pid: 2410 pub: Pergamon Press - An Imprint of Elsevier Science artinfo: ui: 112665765 112665765 112665765 10.1016/j.ejca.2015.08.011 112665765 ppf: 2517 ppct: 8 formats: tig: atl: Cardiac assessment of early breast cancer patients 18 years after treatment with cyclophosphamide-, methotrexate-, fluorouracil- or epirubicin-based chemotherapy. aug: au: de Azambuja, Evandro Ameye, Lieveke Diaz, Marie Vandenbossche, Sandrine Aftimos, Philippe Hernández, Sara Bejarano Shih-Li, Chao Delhaye, François Focan, Christian Cornez, Nathalie Vindevoghel, Anita Beauduin, Marc Lemort, Marc Paesmans, Marianne Suter, Thomas Piccart-Gebhart, Martine affil: Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium sug: subj: Breast Neoplasms Drug Therapy Cyclophosphamide Therapeutic Use Methotrexate Therapeutic Use Fluorouracil Therapeutic Use Epirubicin Therapeutic Use Drug Therapy, Combination Cardiotoxicity Treatment Complications, Delayed Human Female Clinical Trials Ventricular Ejection Fraction Evaluation Heart Failure Diagnosis Systolic Pressure Ventricular Dysfunction, Left Diagnosis Chi Square Test Fisher's Exact Test T-Tests Wilcoxon Rank Sum Test P-Value Descriptive Statistics Prospective Studies Statistical Significance Heart Rate Evaluation Echocardiography Magnetic Resonance Imaging Female ab: Background Epirubicin-based chemotherapy improves the outcome of early breast cancer (BC) patients. However, cardiotoxicity remains an important side effect. Methods We re-consented node-positive BC patients enrolled in a phase III trial between 1988 and 1996 which compared six cycles of oral cyclophosphamide, methotrexate, fluorouracil (CMF) versus two epirubicin–cyclophosphamide regimens differing by the anthracycline cumulative dose [standard-dose epirubicin and cyclophosphamide (SDE) (8 × 60 mg/m 2 ) and higher-dose epirubicin and cyclophosphamide (HDE) (8 × 100 mg/m 2 )]. Eligible patients were those who were alive and free of disease and had no contra-indications to the proposed tests (cardiac evaluation). Cardiotoxicity was defined as asymptomatic systolic dysfunction (left ventricular ejection fraction (LVEF) < 50%, New York Heart Association (NYHA) Class I) or symptomatic heart failure (NYHA Class II–IV). Differences in cardiotoxicity between CMF and SDE/HDE were assessed using chi-square and Fisher Exact tests for binary variables and t -test and Wilcoxon test for continuous variables. Results Among the 777 patients, 20 cases of CHF were reported (CMF = 1, SDE = 5, HDE = 14; p < 0.001). Between September 2010 and June 2013, 82 patients (30%) out of 269 eligible patients accepted to participate in this substudy. Median follow-up was 18 years (range 15–24). Epirubicin-treated patients had significantly higher heart rate, more abnormal echocardiograms and LVEF by magnetic resonance imaging (MRI) compared to CMF-treated ones. A trend towards higher BNP was also observed in the SDE/HDE group ( P = 0.08). No differences were observed in LVEF assessed by echocardiogram or troponin T levels. Conclusions Participation rate in this substudy was lower than expected highlighting the complexity of re-calling patients several years after the initial BC diagnosis. After 18 years, epirubicin-treated patients had a lower LVEF by MRI, more abnormal echocardiograms, higher heart rates compared to patients treated with CMF. However, no major delayed cardiotoxicity was observed. pubtype: Academic Journal doctype: clinical trial research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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