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Cardiotoxicity of Epirubicin Versus Doxorubicin: Cost and Clinical Results

Nacogdoches, Texas

To the Editor:

Bonneterre et al¹ assert, "the better cardiac toxicity profile of epirubicin, compared with doxorubicin." Clinical studies do not support this position. In their study of six cycles of FEC-100, two (2.3%) of 85 patients experienced clinical congestive heart failure (CHF). A recent study of doxorubicin in 141 patients treated for lymphoma found only one case of CHF (0. 7%).² In the latter study, the median cumulative dose of doxorubicin was 300 mg/m², with virtually all patients having received > 250 mg/m². This is the same dosage found in doxorubicin-based adjuvant therapies of breast cancer, given at equitherapeutic dose-intensity to FEC-100. Prior "equimolar" comparisions of the two anthracyclines favoring epirubicin are spurious because the drugs are dosed differently to obtain the maximum-tolerated dose.^3,4

The average wholesale cost of an equitherapeutic dose of epirubicin in the United States, where epirubicin is still under patent protection, is more than 22x the cost of doxorubicin.⁵ Outside of an industry-sponsored clinical trial, the substitution of epirubicin for doxorubicin has no compelling advantages for either safety or efficacy.

Author's Disclosure of Potential Conflicts of Interest

The author indicated no potential conflicts of interest.

Acknowledgment

The authors whish to acknowledge Dr Gabriel N. Hortobagyi for reviewing this letter.

REFERENCES

1. Bonneterre J, Roche H, Kerbrat P, et al: Long-term cardiac follow-up in relapse-free patients after six courses of fluorouracil, epirubicin, and cyclophosphamide, with either 50 or 100 mg of epirubicin, as adjuvant therapy for node-positive breast cancer: French Adjuvant Study Group. J Clin Oncol 22:3070-3079, 2004[Abstract/Free Full Text]

2. Hequet O, Le QH, Moullet I, et al: Subclinical late cardiomyopathy after doxorubicin therapy for lymphoma in adults. J Clin Oncol 22:1864-1871, 2004[Abstract/Free Full Text]

3. Jain KK, Casper ES, Geller NL, et al: A prospective randomized comparison of epirubicin and doxorubicin in patients with advanced breast cancer. J Clin Oncol 3:818-826, 1985[Abstract/Free Full Text]

4. Habeshaw T, Paul J, Jones R, et al: Epirubicin at two dose levels with prednisolone as treatment for advanced breast cancer: The results of a randomized trial. J Clin Oncol 9:295-304, 1991[Abstract]

5. Thomson Red Book Update. October 2004;23:32

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• In Reply:
  Jacques Bonneterre
  JCO 2005 23: 2873-2874 [Full Text]

This Article 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 Google Scholar Google Scholar Articles by Ventura, G. J. Search for Related Content PubMed PubMed Citation Articles by Ventura, G. J. Related Articles Related Reply Social Bookmarking                            What's this?