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Cumulative incidence of chemotherapy-induced cardiotoxicity during a 2-year follow-up period in breast cancer patients

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Abstract

Purpose

Cardiotoxicities are adverse effects often reported in chemotherapy-treated breast cancer patients. This study evaluated the potential risk factors and cumulative incidence of doxorubicin-induced cardiotoxicity in Korean breast cancer patients.

Methods

We retrospectively analyzed the data of 613 breast cancer patients who underwent a multigated acquisition (MUGA) scan or echocardiography prior to chemotherapy and at least one post-chemotherapy follow-up MUGA scan/echocardiography between 2007 and 2016 at National Cancer Center, Korea. The Cox proportional hazards models were used to evaluate cardiotoxicity risks. Competing risks analyses were performed to estimate cumulative incidence of cardiotoxicity.

Results

Risk factors associated with cardiotoxicity within 2 years of doxorubicin administration included age [adjusted hazard ratio (aHR) = 1.02, 95% confidence interval (CI) 1.00–1.04; p = 0.05], metastasis (aHR = 2.66; 95% CI 1.36–5.20; p < 0.01), and concomitant trastuzumab (aHR = 4.08; 95% CI 2.31–7.21; p < 0.01). The cumulative incidence of patients with cardiotoxicity was 6.1% at 2 years (without substantial change from about 9 months)and 20.2% at 2 years (without substantial change from about 15 months) after initiation of doxorubicin-containing therapy without and with trastuzumab, respectively.

Conclusions

Susceptibility to chemotherapy-induced cardiotoxicity within 2 years of doxorubicin initiation in breast cancer patients was elevated with old age, metastasis, and concomitant trastuzumab. Regular imaging monitoring at least up to 9 months after doxorubicin initiation in patients treated without concomitant trastuzumab, and 15 months in patients treated with concomitant trastuzumab, is needed for early detection of chemotherapy-induced cardiotoxicity.

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Funding

This work was supported by grants from the National Cancer Center (NCC1710321-1, 1810301-1, 1710300-3, 1831140-1), Republic of Korea.

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Authors and Affiliations

  1. Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Korea

    Hyunsoon Cho & Sanghee Lee

  2. Division of Cancer Registration and Surveillance, National Cancer Control Institute, National Cancer Center, Goyang, Korea

    Hyunsoon Cho

  3. Branch of Hemato-Oncology, Department of Internal Medicine, National Cancer Center, Goyang, Korea

    Sung Hoon Sim, In Hae Park & Keun Seok Lee

  4. Department of Hemato-Oncology, College of Medicine, Korea University, Seoul, Korea

    In Hae Park

  5. Branch of Cardiology, Department of Internal Medicine, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea

    Mi Hyang Kwak & Hak Jin Kim

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  1. Hyunsoon Cho
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Contributions

HC: Conceptualization, methodology, and writing—original draft. SL: data curation, formal analysis, and writing—review and editing. SHS: validation and writing—review and editing. IHP: validation and writing—review and editing. KSL: validation and writing—review and editing. MHK: validation and writing—review and editing. HJK: conceptualization, supervision, and writing—original draft.

Corresponding author

Correspondence to Hak Jin Kim.

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The authors have no conflict of interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study protocol and data were approved by the Institutional Review Board of the National Cancer Center (NCC2017-0013) in Korea.

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Informed consent was not required due to the retrospective use of de-identified administrative data.

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Cho, H., Lee, S., Sim, S.H. et al. Cumulative incidence of chemotherapy-induced cardiotoxicity during a 2-year follow-up period in breast cancer patients. Breast Cancer Res Treat 182, 333–343 (2020). https://doi.org/10.1007/s10549-020-05703-5

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  • DOI: https://doi.org/10.1007/s10549-020-05703-5

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