Breast Cancer Research and Treatment

, Volume 104, Issue 3, pp 341–349

Long-term assessment of cardiac function after dose-dense and -intense sequential doxorubicin (A), paclitaxel (T), and cyclophosphamide (C) as adjuvant therapy for high risk breast cancer

  • Maysa M. Abu-Khalaf
  • Vinni Juneja
  • Gina G. Chung
  • Michael P. DiGiovanna
  • Rebecca Sipples
  • Meghan McGurk
  • Daniel Zelterman
  • Bruce Haffty
  • Michael Reiss
  • Frans J. Wackers
  • Forrester A. Lee
  • Barbara A. Burtness
Original Paper

DOI: 10.1007/s10549-006-9413-7

Cite this article as:
Abu-Khalaf, M.M., Juneja, V., Chung, G.G. et al. Breast Cancer Res Treat (2007) 104: 341. doi:10.1007/s10549-006-9413-7

Abstract

Objectives

This study evaluated the incidence of late cardiotoxicity after dose-dense and -intense adjuvant sequential doxorubicin (A), paclitaxel (T), and cyclophosphamide (C) for breast cancer (BC) with ≥ 4 involved ipsilateral axillary lymph nodes.

Methods

Patients were enrolled from 1994 to 2001 after definitive BC surgery if ≥4 axillary nodes were involved. Planned treatment was A 90 mg/m2 q 14 days × 3, T 250 mg/m2 q 14 days × 3, C 3 g/mq 14 days × 3 with filgrastim (G) support. Left ventricular ejection fraction (LVEF) was monitored using equilibrium radionuclide angiography (ERNA) before the initiation of chemotherapy, and after three cycles of each chemotherapeutic agent. At a median follow-up of 7 years, we obtained ERNA scans on 32 patients to evaluate the long-term cardiotoxicity of this regimen.

Results

Eighty-five eligible patients enrolled on the treatment protocol. Clinical heart failure developed in one patient. Seven (8%) patients had LVEF < 50% at the end of therapy. No cardiac-related deaths occurred. Thirty-two (46%) of 69 surviving patients have consented to late cardiac imaging. At a median follow-up of 7 years, the median absolute change in LVEF from baseline was -5.5%; [range (−8%) to (+36%)], and from the end of chemotherapy was −2.0%; [range (−25%) to (+16%)]. Four patients (12%) had a LVEF < 50%; two of these four patients had an LVEF of < 50% at the end of chemotherapy.

Conclusions

Late development of asymptomatic decline in cardiac function may occur after dose-dense and -intense adjuvant therapy, but is uncommon.

Keywords

Anthracycline Adjuvant therapy Breast cancer Cardiac dysfunction 

Copyright information

© Springer Science+Business Media, LLC 2006

Authors and Affiliations

  • Maysa M. Abu-Khalaf
    • 1
  • Vinni Juneja
    • 1
  • Gina G. Chung
    • 1
  • Michael P. DiGiovanna
    • 1
  • Rebecca Sipples
    • 1
  • Meghan McGurk
    • 1
  • Daniel Zelterman
    • 2
  • Bruce Haffty
    • 3
  • Michael Reiss
    • 4
  • Frans J. Wackers
    • 5
  • Forrester A. Lee
    • 5
  • Barbara A. Burtness
    • 6
  1. 1.Department of Internal Medicine, Section of Medical OncologyYale University School of Medicine, Yale Cancer CenterNew HavenUSA
  2. 2.Division of BiostatisticsYale UniversityNew HavenUSA
  3. 3.Department of Radiation Oncology, UMDNJ-Robert Wood Johnson Medical SchoolCancer Institute of New JerseyNew BrunswickUSA
  4. 4.Department of Internal Medicine, Section of Medical Oncology, UMDNJ-Robert Wood Johnson Medical SchoolCancer Institute of New JerseyNew BrunswickUSA
  5. 5.Department of Internal Medicine, Section of CardiologyYale University School of MedicineNew HavenUSA
  6. 6.Department of Medical OncologyDivision of Medical Sciences, Fox Chase Cancer CenterPhiladelphiaUSA