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August 30, 2012JNCI Journal of the National Cancer InstituteOpen Access

Risk of Heart Failure in Breast Cancer Patients After Anthracycline and Trastuzumab Treatment: A Retrospective Cohort Study

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Why the study?

Does anthracycline and/or trastuzumab increase the risk of incident heart failure and/or cardiomyopathy in women with invasive breast cancer compared to no chemotherapy?

Population

12,500 women diagnosed with incident, invasive breast cancer, mean age 60 years (range 22-99 years).

Comparison

Anthracycline alone, trastuzumab alone… vs No chemotherapy

Design

Cohort

Authors

EBErin J. Aiello BowlesKaiser Permanente Washington Health Research InstituteRWRobert WellmanKaiser Permanente Washington Health Research InstituteHFHeather Spencer FeigelsonKaiser Permanente

Discussion

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Implication

Supports enhanced cardiac surveillance with trastuzumab; extends trial data to real-world cohorts but leaves optimal prevention strategies open.

Key Points

  • To evaluate real-world adjuvant use of anthracyclines and trastuzumab and assess their associations with incident heart failure or cardiomyopathy among women with breast cancer.
  • Retrospective, population-based cohort study of 12,500 women diagnosed with incident, invasive breast cancer between January 1, 1999, and December 31, 2007, across eight integrated Cancer Research Network health systems.
  • Identified chemotherapy exposures and incident heart failure/cardiomyopathy using administrative procedure and pharmacy codes.
  • Estimated hazard ratios using multivariable Cox proportional hazards regression models adjusted for age at diagnosis, stage, study site, diagnosis year, radiation therapy, and comorbidities.
  • Compared with no chemotherapy, the risk of incident heart failure or cardiomyopathy was elevated in patients treated with anthracycline alone (adjusted HR = 1.40, 95% CI = 1.11 to 1.76) and other chemotherapy (adjusted HR = 1.49, 95% CI = 1.25 to 1.77).
  • Risk of heart failure or cardiomyopathy was substantially higher in patients treated with trastuzumab alone (adjusted HR = 4.12, 95% CI = 2.30 to 7.42) and highest among those receiving anthracycline plus trastuzumab (adjusted HR = 7.19, 95% CI = 5.00 to 10.35).

Structured PICO

Does anthracycline and/or trastuzumab increase the risk of incident heart failure and/or cardiomyopathy in women with invasive breast cancer compared to no chemotherapy?

P
Population
12,500 women diagnosed with incident, invasive breast cancer, mean age 60 years (range 22-99 years).
I
Intervention
Anthracycline alone, trastuzumab alone, anthracycline plus trastuzumab, or other chemotherapy
C
Comparator
No chemotherapy
O
Outcome
Incident heart failure and/or cardiomyopathy (HF/CM)safety

In a real-world cohort of women with breast cancer, treatment with anthracycline and/or trastuzumab was associated with a significantly increased risk of incident heart failure or cardiomyopathy compared to no chemotherapy.

Cite This Study

Bowles et al. (2012) studied this question.

synapsesocial.com/papers/69fbd6c6df6507d4845ddad2https://doi.org/10.1093/jnci/djs317

Topics

Heart failureHFrEF treatment
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Also Consider

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