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November 1, 1990Journal of Clinical Oncology

Epirubicin cardiotoxicity: a study of 135 patients with advanced breast cancer.

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Why the study?

Does cumulative epirubicin dose correlate with the risk of congestive heart failure in patients with advanced breast cancer?

Population

135 patients with advanced breast cancer

Design

Cohort

Authors

DNDorte NielsenUniversity of CopenhagenJJJørgen Bjerggaard JensenAarhus UniversityPDP DombernowskyUniversity of Copenhagen

Discussion

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Implication

Cumulative epirubicin dose was associated with CHF incidence in advanced breast cancer; leaves open safe thresholds and LVEF utility pending trials.

Key Points

  • Evaluate the clinical cardiotoxicity of epirubicin and determine the predictive value of resting left ventricular ejection fraction for congestive heart failure in advanced breast cancer.
  • Monitored 135 patients with advanced breast cancer receiving epirubicin (60 mg/m2 on days 1 and 8 every 4 weeks, or 45 mg/m2 plus vindesine 3 mg/m2 on the same schedule; median cumulative dose 500 mg/m2, range 47 to 1,563 mg/m2).
  • Assessed cardiac function clinically, radiologically, with electrocardiography, and through rest left ventricular ejection fraction (LVEF) using multiple ECG-gated radionuclide determinations.
  • Congestive heart failure (CHF) occurred in 8 of 135 patients (6%), with 0 of 67 patients at doses <500 mg/m2, 1 of 48 patients (2%; 95% CL, 0.1 to 11.1) at 500–1,000 mg/m2, and 7 of 20 patients (35%; 95% CL, 15.4 to 59.2) at 1,000–1,563 mg/m2, resulting in 4 deaths.
  • Resting LVEF demonstrated poor clinical utility as a predictor for CHF, showing a sensitivity of only 64% and a maximum specificity of 62% among patients receiving more than 1,000 mg/m2.

Structured PICO

Does cumulative epirubicin dose correlate with the risk of congestive heart failure in patients with advanced breast cancer?

P
Population
135 patients with advanced breast cancer
I
Intervention
Epirubicin 60 mg/m2 on days 1 and 8 every 4 weeks or 45 mg/m2 plus vindesine 3 mg/m2 on the same schedule
O
Outcome
Congestive heart failure (CHF) and cardiotoxicitysafety

Epirubicin cardiotoxicity is highly dose-dependent, with significant risk of congestive heart failure at cumulative doses above 1,000 mg/m2, and resting LVEF is a poor predictor of this complication.

Cite This Study

Nielsen et al. (1990) studied this question.

synapsesocial.com/papers/6a7b99fa0449e558d7c28b81https://doi.org/10.1200/jco.1990.8.11.1806

Topics

Women and heart disease
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Right and left ventricular ejection fraction and left ventricular volume changes at rest and during exercise in normal subjects1984 · 29 citations
  2. 2A prospective randomized comparison of epirubicin and doxorubicin in patients with advanced breast cancer.1985 · 251 citations
  3. 3Epirubicin: a review of the pharmacology, clinical activity, and adverse effects of an adriamycin analogue.1986 · 300 citations
  4. 4Risk Factors for Doxorubicin-lnduced Congestive Heart Failure1979 · 2,439 citations
  5. 5Randomized phase II trial of carminomycin versus 4'-epidoxorubicin in advanced breast cancer.1984 · 24 citations