Angel Qin1, Cheryl L Thompson, Paula Silverman. 1. Department of Medicine, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA, angel.qin@uhhospitals.org.
Abstract
PURPOSE: Anthracyclines are an integral component of breast cancer chemotherapy. They exert many cardiotoxic effects, including heart failure. The onset of anthracycline-induced heart failure (AIHF) can occur years after completion of chemotherapy and incurs significant morbidity and mortality. Few studies have attempted to characterize risk factors for its development. Our purpose was to determine the incidence of early and late AIHF in breast cancer survivors and to identify factors that increase the risk for late-onset AIHF. METHODS: Patients with invasive breast cancer who received doxorubicin-containing chemotherapy at University Hospitals Case Medical Center from 1998 to 2006 were included. Medical history and tumor and treatment characteristics were abstracted from medical records. Patients who developed heart failure were compared to those who did not and were also stratified based on timing of heart failure. RESULTS: One thousand one hundred fifty-three patients received doxorubicin-based chemotherapy for invasive breast cancer with an average follow-up of 7.6 years (standard deviation (SD) = 3.4). The overall incidence of heart failure was 10.4, with a 2.9 and 7.6 % incidence of early- and late-onset heart failure, respectively. Human epidermal growth factor receptor 2 (HER2) status, hypertension, and coronary artery disease were significant predictors for both heart failure groups (p < 0.001). Type II diabetes was a risk factor for the late-onset AIHF group (p < 0.001). CONCLUSIONS: HER2 status and cardiovascular risk factors increased the risk of heart failure among doxorubicin users. Patients with type II diabetes were at increased risk of late-onset AIHF. IMPLICATIONS FOR CANCER SURVIVORS: We identified at risk survivors who may benefit from prolonged monitoring and/or early intervention.
PURPOSE:Anthracyclines are an integral component of breast cancer chemotherapy. They exert many cardiotoxic effects, including heart failure. The onset of anthracycline-induced heart failure (AIHF) can occur years after completion of chemotherapy and incurs significant morbidity and mortality. Few studies have attempted to characterize risk factors for its development. Our purpose was to determine the incidence of early and late AIHF in breast cancer survivors and to identify factors that increase the risk for late-onset AIHF. METHODS:Patients with invasive breast cancer who received doxorubicin-containing chemotherapy at University Hospitals Case Medical Center from 1998 to 2006 were included. Medical history and tumor and treatment characteristics were abstracted from medical records. Patients who developed heart failure were compared to those who did not and were also stratified based on timing of heart failure. RESULTS: One thousand one hundred fifty-three patients received doxorubicin-based chemotherapy for invasive breast cancer with an average follow-up of 7.6 years (standard deviation (SD) = 3.4). The overall incidence of heart failure was 10.4, with a 2.9 and 7.6 % incidence of early- and late-onset heart failure, respectively. Human epidermal growth factor receptor 2 (HER2) status, hypertension, and coronary artery disease were significant predictors for both heart failure groups (p < 0.001). Type II diabetes was a risk factor for the late-onset AIHF group (p < 0.001). CONCLUSIONS:HER2 status and cardiovascular risk factors increased the risk of heart failure among doxorubicin users. Patients with type II diabetes were at increased risk of late-onset AIHF. IMPLICATIONS FOR CANCER SURVIVORS: We identified at risk survivors who may benefit from prolonged monitoring and/or early intervention.
Authors: Dennis Slamon; Wolfgang Eiermann; Nicholas Robert; Tadeusz Pienkowski; Miguel Martin; Michael Press; John Mackey; John Glaspy; Arlene Chan; Marek Pawlicki; Tamas Pinter; Vicente Valero; Mei-Ching Liu; Guido Sauter; Gunter von Minckwitz; Frances Visco; Valerie Bee; Marc Buyse; Belguendouz Bendahmane; Isabelle Tabah-Fisch; Mary-Ann Lindsay; Alessandro Riva; John Crown Journal: N Engl J Med Date: 2011-10-06 Impact factor: 91.245
Authors: D D Von Hoff; M W Layard; P Basa; H L Davis; A L Von Hoff; M Rozencweig; F M Muggia Journal: Ann Intern Med Date: 1979-11 Impact factor: 25.391
Authors: Edward H Romond; Jong-Hyeon Jeong; Priya Rastogi; Sandra M Swain; Charles E Geyer; Michael S Ewer; Vikas Rathi; Louis Fehrenbacher; Adam Brufsky; Catherine A Azar; Patrick J Flynn; John L Zapas; Jonathan Polikoff; Howard M Gross; David D Biggs; James N Atkins; Elizabeth Tan-Chiu; Ping Zheng; Greg Yothers; Eleftherios P Mamounas; Norman Wolmark Journal: J Clin Oncol Date: 2012-09-17 Impact factor: 44.544
Authors: Elly Barry; Jorge A Alvarez; Rebecca E Scully; Tracie L Miller; Steven E Lipshultz Journal: Expert Opin Pharmacother Date: 2007-06 Impact factor: 3.889
Authors: Joseph T Poterucha; Shelby Kutty; Rebecca K Lindquist; Ling Li; Benjamin W Eidem Journal: J Am Soc Echocardiogr Date: 2012-05-10 Impact factor: 5.251
Authors: Judy N Jacobse; Lars C Steggink; Gabe S Sonke; Michael Schaapveld; Yoran M Hummel; Tessa G Steenbruggen; Joop D Lefrandt; Janine Nuver; Anne P G Crijns; Berthe M P Aleman; Peter van der Meer; Jourik A Gietema; Flora E van Leeuwen Journal: Eur J Heart Fail Date: 2019-11-06 Impact factor: 15.534
Authors: Kaytee L Pokrzywinski; Thomas G Biel; Elliot T Rosen; Julia L Bonanno; Baikuntha Aryal; Francesca Mascia; Delaram Moshkelani; Steven Mog; V Ashutosh Rao Journal: Biol Sex Differ Date: 2018-06-15 Impact factor: 5.027