Effect of standard low-dose anthracycline chemotherapy on late congestive heart failure in breast cancer survivors aged between 50 and 59 at diagnosis: A nationwide study

Abstract

Objectives Although chemotherapy-induced congestive heart failure (CHF) is a well-known adverse event in cancer survivors, the long-term risk of standard low-dose anthracycline has not yet been reported. This study aimed to investigate the long-term effects of standard anthracycline on late CHF in breast cancer survivors. Materials and methods A nationwide retrospective cohort study was conducted using the national insurance claims data for nearly 98% of Korean citizens. Between Jan 2010 and Dec 2015, a total of 56,338 newly diagnosed female breast cancer survivors were included. Results The total number of person-years was 199,648 and the incidence rate of late CHF was 3.57 per 1000 person-years. In multivariate analysis according to the subject’s age at diagnosis, only in the 50–59 age group, anthracycline-based [hazard ratio (HR) 1.765, 95% confidence interval (CI) 1.206–2.583] and taxane plus anthracycline-based regimens (HR 1.816, 95% CI 1.192–2.768) significantly increased the risk of late CHF. In the 50–59 age group, standard low-dose anthracycline significantly increased the risk of late CHF (HR 1.627, 95% CI 1.080–2.451) in Cox proportional hazard regression models. In competing risk model with recurrence and in-hospital death as competing risks, standard low-dose anthracycline was a significant risk factor for late CHF [subdistribution hazard ratio (SHR) 1.553, 95% CI 1.029–2.340]. Conclusion This nationwide study showed that standard chemotherapy with low-dose anthracycline is a risk factor for late-onset CHF in breast cancer survivors who were in their 50 s at breast cancer diagnosis. Long-term monitoring of late CHF should be considered in these younger breast cancer survivors.

Risk of heart disease following treatment for breast cancer – results from a population-based cohort study

“…Although the benefits of radiotherapy far outweigh the risk of heart diseases, some studies have found increased incidence of and mortality due to heart disease in women subjected to radiotherapy techniques ( Darby et al, 2013 ; Taylor et al, 2017 ). Knowledge on cardiotoxic effects of anthracycline-based chemotherapy regimens have led to lowering of doses and less use of bolus injections to reduce peak concentrations of anthracyclines ( Foukakis et al, 2016 ), but it is estimated that the risk of heart failure associated with anthracyclines remains increased for standard low-dose group as compared to non-users ( Chung et al, 2020 ). While trastuzumab has been shown to reduce the risk of breast cancer mortality at 11 years of follow-up ( Cameron et al, 2017 ), evidence on its cardiotoxicity is conflicting ( Bowles et al, 2012 ; Papakonstantinou et al, 2020 ).…”

Profile, treatment patterns, and influencing factors of anthracycline use in breast cancer patients in China: A nation‐wide multicenter study

“…Emerging studies emphasized the adverse effects of anthracyclines, and further efforts have been made to prevent and treat them, especially against cardiotoxicity 19–21 . Several drugs and/or therapies are proposed as cardioprotective agents/approaches during the treatment with ABC, such as dexrazoxane, β‐blockers, ACE inhibitors, telomerase therapy, and matrix metalloproteinase inhibitors 22–26 .…”

Risk of heart disease following breast cancer: results from a population-based cohort study

“…Taylor et al, 2017). Knowledge on cardiotoxic effects of anthracycline-based chemotherapy regimens have led to lowering of doses and less use of bolus injections to reduce peak concentrations of anthracyclines (Foukakis et al, 2016), but it is estimated that the risk of heart failure associated with anthracyclines remains increased for standard low-dose group as compared to non-users (Chung et al, 2020).…”