Annals of Oncology Advance Access originally published online on July 19, 2005
Annals of Oncology 2005 16(12):1979-1980; doi:10.1093/annonc/mdi387
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© 2005 European Society for Medical Oncology
Letter to the Editor |
Reply to "Weekly paclitaxel in elderly breast cancer patients", by C. Smorenburg et al. (Ann Oncol 2005; 16: 1979)
Smorenburg and ten Tije rightly suggest that the higher than previously reported rate of cardiotoxicity observed in the GIOGer study on weekly paclitaxel in elderly patients [1
] may be correlated with previous anthracycline-containing adjuvant chemotherapy received by the patients. Development of both clinical and subclinical long-term cardiotoxicity occurred slightly more frequently in patients previously treated with anthracycline-containing regimens as compared with patients not treated with anthracyclines [2], as well as more frequently in patients who had received a high dose of anthracyclines as compared with those treated with a low dose of such drugs [3]. These data indicate that patients treated with anthracyclines may suffer cardiac damage, with a subsequent high risk of cardiac events. In our study, out of 46 patients who received weekly paclitaxel, 19 had received previous chemotherapy (15 as adjuvant only, one as neo-adjuvant only, and three as both neo-adjuvant and adjuvant). Of these, eight had never received anthracyclines, eight had been treated with epirubicin-containing regimens and three with mitoxantrone-based chemotherapy. As shown in Table 1, there was no relationship between previous chemotherapy and development of cardiac toxicity. Although the low number of events does not allow a potential role of previous anthracycline-containing chemotherapy to be completely ruled out as a risk factor for cardiotoxicity development, our results indicate that elderly patients receiving chemotherapy, because of the increased risk of cardiotoxicity related to both their age [4] and the frequent presence of other concomitant disease [5], should be monitored closely regardless of the previous adjuvant treatment received.
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1 Department of Medical Oncology, National Cancer Research Institute, Genoa; 2 Clinical Trials Unit, NCI, Naples, Italy
* E-mail: lucia.delmastro{at}istge.it
References
1. Del Mastro L, Perrone F, Repetto L et al. Weekly paclitaxel as first-line chemotherapy in elderly advanced breast cancer patients: a phase II study of the Gruppo Italiano di Oncologia Geriatria (GIOGer). Ann Oncol 2005; 16: 253–258.
2. Zambetti M, Moliterni A, Materazzo C et al. Long-term cardiac sequelae in operable breast cancer patients given adjuvant chemotherapy with or without doxorubicin and breast irradiation. J Clin Oncol 2001; 19: 37–43.
3. Bonneterre J, Rochè 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 2004; 22: 3070–3079.
4. Venturini M, Michelotti A, Del Mastro L et al. Multicenter randomized controlled clinical trial to evacuate cardioprotection with dexrazoxane versus no cardioprotection in women receiving chemotherapy for advanced breast cancer. J Clin Oncol 1996; 14: 3112–3120.[Abstract]
5. Singal PK, Iliskovic N. Doxorubicin-induced cardiomyopathy. N Engl J Med 1998; 339: 900–905.
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