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Cardiac risk associated with the receipt of anthracycline and trastuzumab in a large nationwide cohort of older women with breast cancer, 1998–2005

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Abstract

To determine the risk of cardiotoxicities in association with trastuzumab with/without anthracycline-containing chemotherapy in a large nationwide population-based cohort of patients with breast cancer. We studied 47,806 women with breast cancer ages ≥65 in 1998–2005 from 16 cancer registries in the Surveillance, Epidemiology and End Results (SEER)-Medicare data and 16,092 cases matched with equal number of controls on the propensity of receiving chemotherapy or trastuzumab. Cumulative incidence of congestive heart failure in year-1 was 5.5% for patients receiving anthracycline and trastuzumab and 3.2% for those receiving anthracycline without trastuzumab. The cumulative incidence of congestive heart failure in year-5 was 15.5 and 9.1%, respectively. Compared to those without chemotherapy and trastuzumab, patients treated with anthracycline-containing chemotherapy and no trastuzumab were 19% significantly more likely to develop congestive heart failure (hazard ratio = 1.19, 95% CI = 1.05–1.34), whereas those receiving trastuzumab without anthracycline and those receiving both trastuzumab and anthracycline were 1.97 and 2.37 times more likely to develop congestive heart failure after adjusting for patient and tumor characteristics. Concurrent or sequential use of anthracycline and trastuzumab was associated with a greater risk of congestive heart failure and cardiomyopathy. Carefully monitoring cardiac functions in patients receiving anthracycline and trastuzumab is warranted.

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Acknowledgments

We acknowledge the efforts of the National Cancer Institute; Center for Medicare and Medicaid Services; Information Management Services, Inc.; and the Surveillance, Epidemiology, and End Results Program tumor registries in the creation of this database. The interpretation and reporting of these data are the sole responsibilities of the authors. This study was supported in part by a grant from the Agency for Healthcare Research and Quality (R01-HS016743).

Conflict of interest

All authors have no conflicts of interest to disclose.

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Authors and Affiliations

  1. Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston, TX, USA

    Xianglin L. Du, Rui Xia & Chih-Chin Liu

  2. Center for Health Service Research, University of Texas School of Public Health, 1200 Herman Pressler Drive, RAS-E631, Houston, TX, 77030, USA

    Xianglin L. Du

  3. Division of Biostatistics, University of Texas School of Public Health, Houston, TX, USA

    Keith Burau

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  1. Xianglin L. Du
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  2. Rui Xia
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Correspondence to Xianglin L. Du.

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Du, X.L., Xia, R., Burau, K. et al. Cardiac risk associated with the receipt of anthracycline and trastuzumab in a large nationwide cohort of older women with breast cancer, 1998–2005. Med Oncol 28 (Suppl 1), 80–90 (2011). https://doi.org/10.1007/s12032-010-9717-7

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  • DOI: https://doi.org/10.1007/s12032-010-9717-7

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