Breast Cancer Therapy–Related Cardiac Dysfunction in Adult Women Treated in Routine Clinical Practice: A Population-Based Cohort Study

Thavendiranathan, Paaladinesh; Abdel‐Qadir, Husam; Fischer, Hadas D.; Camacho, Ximena; Amir, Eitan; Austin, Peter C.; Lee, Douglas S.

doi:10.1200/jco.2015.65.1505

Cited by 125 publications

(80 citation statements)

References 31 publications

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“…This disagrees with other studies from India where 34% of the cases were luminal A, followed by TNBC (25%); whereas luminal B and Her2/neu subtypes had same prevalence (18% of each) [41]. Studies in Ghana indicated 25.6% of luminal A, 12.2% of luminal B and 49.9% of TNBC (27). The reasons for these difference results might be due to several reasons like variation in sampling size, method, period and protocol, in addition to reproductive factors, environmental and genetic factors [13,42].…”

Section: Discussioncontrasting

confidence: 92%

“…In line with our findings, breast cancer in Sudanese women is presented at younger age (52 years) than in the Italian women (63 years) [26]. In addition, the median ages of breast cancer patients in Canada, Germany and Belgium are 54, 58 and 58 years, respectively [27][28][29]. More interestingly, studies from some Asian countries indicated an equivalent median age of the breast cancer patients as in our study [30][31][32].…”

Section: Discussionsupporting

confidence: 90%

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Biological and Clinicopathological Characteristics of Breast Cancer at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

Shenkutie¹,

Mekonnen²,

Seifu³

et al. 2017

J Cancer Sci Ther

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Breast cancer (BC) is one of the most heterogeneous types of cancer and is characterized by several molecular subtypes. Descriptive cross-sectional study was conducted on 137 confirmed BC cases at Tikur Anbessa Specialized Hospital (TASH) in Ethiopia from December 2015 to November 2016 to assess the biological and clinicopathological characteristics of BC in Ethiopian women patients. Socio-demographic characteristics of the study subjects was obtained with pretested structured interview and clinical data was collected from the Hospital records. Surgical specimens were analysed histopathologically with hematoxyline and eosin staining, and Immunohistochemistry analysis was conducted with specific antibodies to ER, PR and HER2. The mean and median age of the study participants were 47 and 46.7, respectively. More than 50% of the patients were categorized in the age group of 15-40. Sixty percent were in the age group of 41-100. Infiltrating ductal carcinoma was the most common type of BC (70%) in this study, followed by lobular carcinoma (8.5%). Almost all of the BC cases under study were at advanced stage of the disease: 48.5% were with stage III and 51% were grade II tumors. Half of the study participants belonged to T2 tumor size (2-5 cm) and 52.3% of the patients had axillary lymph node metastases. Sixty five percent were ER+, 58% were PR+ and 28% were HER2+. Luminal A was the most common tumor subtype (54%), followed by luminal B (22%) and TNBC (18%). Based on crude analysis, patients with family history of BC had a lesser likelihood of being ER+ as compared to those patients with no family history of BC [COR=0.10 (95% CI: 0.028, 0.34)]. None of the other risk factors were correlated with the prevalence of ER+ results. In conclusion, the age distribution of BC cases in this study suggests the need to create awareness and improvement of advanced diagnostic services and make available screening programs for younger people. In a resource poor setting like Ethiopia, the use of anti-estrogens (like tamoxifen) in treatment of BC cases with undetermined receptor status could be helpful as most BC cases are ER+ and hormonal therapy is relatively easily available.

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Section: Discussioncontrasting

confidence: 92%

Section: Discussionsupporting

confidence: 90%

Biological and Clinicopathological Characteristics of Breast Cancer at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

Shenkutie¹,

Mekonnen²,

Seifu³

et al. 2017

J Cancer Sci Ther

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“…These results are discordant with those recently published, 53,54 which demonstrated in large population-based retrospective cohort studies that risk of clinical cardiotoxicity, as assessed by congestive heart failure or cardiac death, was higher in patients with breast cancer who received a sequential therapy-anthracyclines followed by trastuzumab-than in those who were treated with other drug regimens. However, these studies used administrative billing codes to identify a congestive heart failure end point, usually associated with a much higher rate of cardiotoxicity.…”

Section: Rates Of Cardiotoxic Eventssupporting

confidence: 80%

Obesity As a Risk Factor for Anthracyclines and Trastuzumab Cardiotoxicity in Breast Cancer: A Systematic Review and Meta-Analysis

Guenancia

Lefebvre

Cardinale

et al. 2016

JCO

154

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International audiencePurposePatients with metabolic syndrome have a greater risk of cardiovascular disease, although their susceptibility to chemotherapy-induced cardiac disease is not well documented. The aim of this meta-analysis was to assess associations between obesity or being overweight and cardiotoxicity from anthracyclines and sequential anthracyclines and trastuzumab in patients with breast cancer.MethodsWe performed a random-effects analysis and a network meta-analysis and assessed publication bias. We included 15 studies and 8,745 patients with breast cancers who were treated with anthracyclines and sequential anthracyclines and trastuzumab.ResultsCombination of obesity and being overweight was significantly associated with a greater risk of developing cardiotoxicity after anthracyclines and a sequential anthracyclines and trastuzumab regimen in patients with breast cancer. Pooled odds ratio for cardiotoxicity was 1.38 (95% CI, 1.06 to 1.80; I-2 = 43%; N = 8,745) for overweight or obesity (body mass index. 25 kg/m(2)), 1.47 (95% CI, 0.95 to 2.28; I-2 = 47%; n = 2,615) for obesity, and 1.15 (95% CI, 0.83 to 1.58; I-2 = 27%; n = 2,708) for overweight. Associations were independent of study design, year of publication, drug regimen (anthracyclines alone v sequential anthracyclines and trastuzumab), or definitions of cardiotoxicity and of overweight or obesity. There was no evidence of publication bias; however, we could not separate the contributions of obesity-related cardiovascular risk factors, such as diabetes and hypertension, from that of obesity itself in this largely unadjusted analysis.ConclusionOur findings in a largely unadjusted analysis suggest that overweight and obesity are risk factors for cardiotoxicity from anthracyclines and sequential anthracyclines and trastuzumab

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“…A systematic review of randomized controlled trials on adjuvant trastuzumab (vs. chemotherapy alone) including patients >60 years noted only a 5% pooled proportion of cardiac events [60]. In contrast, population-based studies have reported higher incidence rates of cardiac events in older women given trastuzumab ± sequential anthracyclines [61,62], with age >80 years, presence of coronary artery disease or hypertension, and weekly dose administration as contributory risk factors [63]. Strategies to minimize toxicities are therefore critical, such as use of anthracycline-free regimens, i.e.…”

Section: Her2-positive Ebcmentioning

confidence: 99%

Controversial issues in the management of older adults with early breast cancer

Mislang

Cheung

Hamaker

et al. 2017

Journal of Geriatric Oncology

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It is well recognized that the incidence of breast cancer increases significantly with age.Despite this, older people remain under-represented in many clinical trials and their management relies on extrapolation of data from younger patients. Providing an aggressive intervention can be challenging, particularly in less fit older patients where a conservative approach is commonly perceived to be more appropriate. The optimal management of this population is unknown and treatment decision should be personalized. This review article will discuss several controversial issues in managing older adults with early breast cancer in a multidisciplinary setting, including the role of surgical treatment of the axilla in clinically node negative disease, radiotherapy after breast conservation surgery in low-risk tumors, personalizing adjuvant systemic therapy, and geriatric assessments in breast cancer treatment decisions.

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Breast Cancer Therapy–Related Cardiac Dysfunction in Adult Women Treated in Routine Clinical Practice: A Population-Based Cohort Study

Abstract: In women with breast cancer and an age distribution representative of routine clinical practice, trastuzumab-based regimens, including those without anthracyclines, were associated with an increased risk of cardiotoxicity. Sequential therapy increased the risk of hospital-based CHF events.

Cited by 125 publications

References 31 publications

Biological and Clinicopathological Characteristics of Breast Cancer at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

Biological and Clinicopathological Characteristics of Breast Cancer at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

Obesity As a Risk Factor for Anthracyclines and Trastuzumab Cardiotoxicity in Breast Cancer: A Systematic Review and Meta-Analysis

Controversial issues in the management of older adults with early breast cancer

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