Originally published as JCO Early Release 10.1200/JCO.2007.11.8877 on January 28 2008

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ganz, P. A. Articles by Albain, K. S. Search for Related Content PubMed PubMed Citation Articles by Ganz, P. A. Articles by Albain, K. S. Related Articles Related Editorial Related Correspondence Social Bookmarking                            What's this?

Late Cardiac Effects of Adjuvant Chemotherapy in Breast Cancer Survivors Treated on Southwest Oncology Group Protocol S8897

Patricia A. Ganz, Michael A. Hussey, Carol M. Moinpour, Joseph M. Unger, Laura F. Hutchins, Shaker R. Dakhil, Jeffrey K. Giguere, J. Wendall Goodwin, Silvana Martino, Kathy S. Albain

From the University of California, Los Angeles, Los Angeles; The Angeles Clinic and Research Institute, Santa Monica, CA; Southwest Oncology Group Statistical Center, Seattle, WA; University of Arkansas for Medical Science, Little Rock, AR; Wichita Community Clinical Oncology Program, Wichita, KS; Greenville Community Clinical Oncology Program, Greenville, SC; Ozarks Regional Community Clinical Oncology Program, Springfield, MO; and Loyola University Stritch School of Medicine, Maywood, IL

Corresponding author: Patricia A. Ganz, MD, Schools of Medicine and Public Health, Division of Cancer Prevention & Control Research, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, 650 Charles Young Dr South, Room A2-125 CHS, Los Angeles, CA 90095-6900; e-mail: pganz{at}ucla.edu

Purpose The late cardiac effects of adjuvant anthracycline therapy in survivors of early-stage breast cancer have had limited study. Subclinical and clinical cardiac late effects may contribute to added comorbidity over time.

Patients and Methods We recruited patients treated on Southwest Oncology Group (SWOG) protocol S8897 who had been randomly assigned to adjuvant chemotherapy with or without doxorubicin. Left ventricular ejection fraction (LVEF) was evaluated at 5 to 8 years and 10 to 13 years after treatment randomization. Cardiac risk factors and events were reported by clinicians annually between the two assessments.

Results A total of 180 breast cancer survivors from a potential sample of 1,176 patients were entered, 163 patients at 5 to 8 years and 17 additional patients at 10 to 13 years, with 93 longitudinal assessments of LVEF. There was no significant difference in the proportion of women with an LVEF less than 50% at 5 to 8 (cyclophosphamide, doxorubicin, and fluorouracil [CAF] v cyclophosphamide, methotrexate, and fluorouracil [CMF]: 5% v 7%; P = .68) or 10 to 13 years (CAF v CMF: 3% v 0%; P = .16); however, in an exploratory analysis, the mean LVEF in the doxorubicin group was statistically significantly lower in the 5- to 8-year sample (64.8% v 61.4%; P = .01) but not in the 10- to 13-year sample. In the longitudinal analysis, there was no significant deterioration in LVEF.

Conclusion Women enrolled onto an adjuvant chemotherapy treatment clinical trial for breast cancer were successfully recruited to participate in a research study of the late effects of treatment, although many SWOG institutions and potentially eligible patients chose not to participate. In this selected sample, with up to 13 years of follow-up, exposure to doxorubicin did not increase the likelihood of adverse cardiac effects.

published online ahead of print at www.jco.org on January 28, 2008.

Supported in part by the following Public Health Service Cooperative Agreement grants awarded by the National Cancer Institute, Department of Health and Human Services: Grants No. CA38926, CA32102, CA35431, CA67663, CA45560, CA37981, CA12644, CA22433, CA35176, CA58416, CA35261, CA58658, CA46113, CA58882, CA13612, CA46441, CA46282, CA04919, CA35090, CA35178, CA35192, CA58723, CA27057, CA16385, CA35281, CA58686, CA52654, CA58861, CA20319, CA35119, CA76447, CA42777, CA45377, CA67575, CA86780, CA12213, CA35996, CA28862, CA35128, and CA35262. Supplemental funding for the Cardiac Evaluation Sub-study was provided by the National Cancer Institute and the Susan G. Komen Foundation.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

Related Editorial

• Left Ventricular Ejection Fraction and Cardiotoxicity: Is Our Ear Really to the Ground?
  Michael S. Ewer and Daniel J. Lenihan
  JCO 2008 26: 1201-1203 [Full Text]

Related Correspondence

• Late Cardiac Effects of Adjuvant Radiotherapy and Chemotherapy in Early Breast Cancer
  Mariarosa Coccaro and Giuseppina Gallucci
  JCO 2008 26: 3288 [Full Text]

This article has been cited by other articles:

				L. Gianni, L. Norton, N. Wolmark, T. M. Suter, G. Bonadonna, and G. N. Hortobagyi Role of Anthracyclines in the Treatment of Early Breast Cancer J. Clin. Oncol., October 1, 2009; 27(28): 4798 - 4808. [Abstract] [Full Text] [PDF]

				K. I. Pritchard Commentary: Anthracyclines in Early-Stage Breast Cancer: Is It the End of an Era? Oncologist, October 1, 2009; 14(10): 959 - 962. [Full Text] [PDF]

				G. Mantovani, C. Madeddu, C. Cadeddu, M. Dessi, A. Piras, E. Massa, R. Serpe, G. Antoni, and G. Mercuro Persistence, Up to 18 Months of Follow-Up, of Epirubicin-Induced Myocardial Dysfunction Detected Early by Serial Tissue Doppler Echocardiography: Correlation with Inflammatory and Oxidative Stress Markers Oncologist, December 1, 2008; 13(12): 1296 - 1305. [Abstract] [Full Text] [PDF]

				L. Gianni, E. H. Herman, S. E. Lipshultz, G. Minotti, N. Sarvazyan, and D. B. Sawyer Anthracycline Cardiotoxicity: From Bench to Bedside J. Clin. Oncol., August 1, 2008; 26(22): 3777 - 3784. [Abstract] [Full Text] [PDF]

				P. A. Ganz, C. M. Moinpour, and J. M. Unger In Reply J. Clin. Oncol., July 1, 2008; 26(19): 3289 - 3289. [Full Text] [PDF]

				M. Coccaro and G. Gallucci Late Cardiac Effects of Adjuvant Radiotherapy and Chemotherapy in Early Breast Cancer J. Clin. Oncol., July 1, 2008; 26(19): 3288 - 3288. [Full Text] [PDF]

				M. S. Ewer and D. J. Lenihan Left Ventricular Ejection Fraction and Cardiotoxicity: Is Our Ear Really to the Ground? J. Clin. Oncol., March 10, 2008; 26(8): 1201 - 1203. [Full Text] [PDF]