April 19, 2016Journal of Clinical Oncology
Breast Cancer Therapy–Related Cardiac Dysfunction in Adult Women Treated in Routine Clinical Practice: A Population-Based Cohort Study
Why the study?
Do trastuzumab-based or anthracycline-based chemotherapy regimens increase the risk of congestive heart failure or cardiovascular death in adult women with stage I to III breast cancer compared to other chemotherapy?
Population
18,540 adult women receiving chemotherapy for stage I to III breast cancer between 2007 and 2012, median age…
Comparison
Trastuzumab-based regimens and… vs Chemotherapy without anthracycline/trastuzumab…
Design
Cohort
Follow-up
3 years
Authors
Discussion
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Implication
Trastuzumab regimens were associated with higher cardiotoxicity in routine-practice women; leaves open need for tailored monitoring in younger patients.
Key Points
- To evaluate the risk of therapy-related cardiotoxicity among women with breast cancer across an age distribution representative of routine clinical practice.
- Conducted a population-based retrospective cohort study of 18,540 adult women receiving chemotherapy for stage I to III breast cancer between 2007 and 2012 across 14 regional cancer centers in Ontario, Canada.
- Categorized chemotherapy regimens into anthracycline without trastuzumab, trastuzumab with nonanthracycline, sequential therapy (anthracyclines followed by trastuzumab), and other chemotherapy.
- Evaluated a composite primary outcome of heart failure hospitalization, emergency department visit, outpatient diagnosis, or cardiovascular death using cause-specific hazard models accounting for competing risks.
- The 3-year cumulative incidence of the primary outcome was 3.08% (95% CI, 2.81% to 3.36%) in treated women compared with 0.96% (95% CI, 0.89% to 1.04%) in 92,700 matched cancer-free controls.
- Compared to other chemotherapy, cardiotoxicity risk was higher with nonanthracycline trastuzumab (HR, 1.76; 95% CI, 1.19 to 2.60) and sequential therapy (HR, 3.96; 95% CI, 3.01 to 5.22).
- Hospital-based congestive heart failure events were significantly increased only among patients treated with sequential therapy (HR, 1.86; 95% CI, 1.07 to 3.22).
Structured PICO
Do trastuzumab-based or anthracycline-based chemotherapy regimens increase the risk of congestive heart failure or cardiovascular death in adult women with stage I to III breast cancer compared to other chemotherapy?
P
Population
18,540 adult women receiving chemotherapy for stage I to III breast cancer between 2007 and 2012, median age 54 years, 79% younger than 65 years.
I
Intervention
Trastuzumab-based regimens (trastuzumab with nonanthracycline chemotherapy, or anthracyclines followed by trastuzumab [sequential therapy]) and anthracycline-based chemotherapy without trastuzumab.
C
Comparator
Chemotherapy without anthracycline/trastuzumab (other chemotherapy), and an age-matched sample of women without breast cancer (n=92,700).
O
Outcome
Composite of hospitalization or emergency room visit for congestive heart failure (CHF), outpatient diagnosis of CHF, or cardiovascular death by 3 years of follow-up.composite
In a real-world population of women with breast cancer, trastuzumab-based regimens and sequential anthracycline-trastuzumab therapy significantly increase the risk of heart failure and cardiovascular death.
Cite This Study
Thavendiranathan et al. (2016) studied this question.