Key result
Adding chemotherapy to hormone therapy is linked to ~30% fewer nonfatal MACE vs hormone therapy alone.
Why the study?
Differences in the risks of major adverse cardiovascular events among hormone receptor-positive early-stage breast cancer patients receiving various adjuvant treatment combinations were unclear.
Does the addition of chemotherapy and/or radiotherapy to hormone therapy increase the risk of fatal and nonfatal MACEs in patients with early-stage breast cancer?
Cohort (n=19,007)
Yes
Does the addition of chemotherapy and/or radiotherapy to hormone therapy increase the risk of fatal and nonfatal MACEs in patients with early-stage breast cancer?
Hazard Ratio: 0.704 (95% CI 0.516–0.961)
Absolute Event Rate: 3.6% vs 7.79%
p-value: p=0.027
Adding chemotherapy or radiotherapy to hormone therapy in early-stage breast cancer does not increase the risk of fatal or nonfatal MACEs compared to hormone therapy alone.
Cardiac monitoring warranted even with hormone therapy alone; leaves open whether adding chemotherapy or radiotherapy alters MACE risk in observational data.
This nationwide population-based study investigated the differences in the risks of major adverse cardiovascular events (MACEs) among patients with hormone receptor-positive early-stage breast cancer undergoing different combinations of adjuvant treatments in Taiwan. Data from the National Health Insurance Research Database (NHIRD) and Taiwan Cancer Registry (TCR) along with the national mortality data were used. Patients who underwent surgery as the first mode of treatment were divided into four groups based on the subsequent adjuvant therapy received: hormone therapy (H), hormone therapy + chemotherapy (CH), hormone therapy + radiotherapy (RH), and hormone therapy + radiotherapy + chemotherapy (CRH) groups. The risks of fatal and nonfatal MACE among the groups were examined using the inverse probability of treatment weighted hazard ratio (IPTW-HR). Adjuvant treatment, age, tumour size, and comorbidities significantly affected the risks of MACEs among the 19,007 patients analysed. For nonfatal MACEs, the IPTW-HR was significantly lower in the CH group compare to the H group (0.704, 95% confidence interval [CI]: 0.516-0.961). No significant differences in the risks for fatal MACE were observed among the four groups. The IPTW-HRs for haemorrhagic stroke in the CH group was 0.424 (95% CI: 0.188-0.957), for congestive heart failure (CHF) in the RH group was 0.260 (95% CI: 0.088-0.762), and for ischaemic heart disease in the CRH group was 0.544 (95% CI: 0.317-0.934). Increase in the adjuvant modality does not necessarily increase the nonfatal or fatal MACE risks. Cardiac health should be monitored even in patients receiving hormone therapy alone.
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Chou et al. (2020) conducted a cohort in Hormone receptor-positive early-stage breast cancer (n=19,007). Chemotherapy and hormone therapy (CH) vs. Hormone therapy alone (H) was evaluated on Nonfatal major adverse cardiovascular events (MACE) (HR 0.704, 95% CI 0.516-0.961, p=0.027). Adding chemotherapy to hormone therapy was associated with a significantly lower risk of nonfatal major adverse cardiovascular events (HR 0.704) compared to hormone therapy alone.
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