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Annals of Oncology Advance Access originally published online on January 12, 2009
Annals of Oncology 2009 20(3):437-440; doi:10.1093/annonc/mdn652
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

breast cancer

Decline in pulmonary function in patients with breast cancer receiving dose-dense chemotherapy: a prospective study

R. Yerushalmi1,*, M. R. Kramer2, S. Rizel1, A. Sulkes1, K. Gelmon3, T. Granot1, V. Neiman1 and S. M. Stemmer1

1 Institute of Oncology, Davidoff Center
2 Institute of Pulmonology, Rabin Medical Center, Beilinson Campus, Petah Tiqva and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
3 BC Cancer Agency, Vancouver, Canada

* Correspondence to: Dr R. Yerushalmi, Institute of Oncology, Davidoff Center, Rabin Medical Center, Beilinson Campus, Soroka Street, Petah Tiqva 49100, Israel. Tel: +972-3-9377377; Fax: +972-3-9242087; E-mail: ryerushalmi{at}bccancer.bc.ca

Background: Prompted by complaints of dyspnea in breast cancer patients receiving adjuvant dose-dense chemotherapy (DDC), we sought to evaluate the possible association of DDC with pulmonary dysfunction.

Patients and methods: A total of 34 consecutive patients receiving adjuvant DDC were enrolled. The chemotherapy regimen consisted of i.v. doxorubicin 60 mg/m2 and cyclophosphamide 600 mg/m2 (AC) every 14 days x4 with growth factor support followed by weekly i.v. paclitaxel 80 mg/m2 x12. The following parameters were prospectively measured before and after the AC protocol (P1, P2) and at completion of paclitaxel treatment (P3): presence of dyspnea, blood pressure, pulse rate, hemoglobin, erythrocyte sedimentation rate, C-reactive protein level, cardiac ejection fraction, and pulmonary function. Repeated measures analysis was used to evaluate differences among the time points, and paired t-test was used to evaluate differences between consecutive time points.

Results: Although only five patients (15%) complained of dyspnea, there was a significant decrease in mean carbon monoxide diffusing capacity (DLCO), in all patients from P1 (22.09 ml/min/mmHg) to P3 (15 ml/min/mmHg) and in 29 of 32 patients (90.6%) from P1 to P2 (15.96 ml/min/mmHg) (P < 0.001).

Conclusions: DDC is associated with a statistical significant reduction in DLCO. Awareness of this potential toxicity may be important in women with preexisting lung disease.

Key words: breast cancer, CRP pulmonary function, DLCO, dose-dense chemotherapy, ESR

Received for publication August 26, 2008. Accepted for publication August 29, 2008.


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