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Annals of Oncology Advance Access published online on October 26, 2005
Annals of Oncology, doi:10.1093/annonc/mdj034
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© 2005 European Society for Medical Oncology
Received March 18, 2005
Revised August 24, 2005
Accepted September 5, 2005

original article

Long-term cardiac toxicity after adjuvant epirubicin-based chemotherapy in early breast cancer: French Adjuvant Study Group Results

P. Fumoleau 1*, H. Roché 2, P. Kerbrat 3, J. Bonneterre 4, P. Romestaing 5, P. Fargeot 1, M. Namer 6, A. Monnier 7, P. Montcuquet 8, M.-J. Goudier 9, E. Luporsi 10, and On behalf of the French Adjuvant Study Group

1 Centre Georges-François Leclerc, Dijon, France
2 Institut Claudius Régaud, Toulouse, France
3 Centre Eugène Marquis, Rennes, France
4 Centre Oscar Lambret, Lille, France
5 Centre Hospitalier Jules Courmont, Lyon, France
6 Centre Antoine Lacassagne, Nice, France
7 Centre Hospitalier André Boulloche, Montbéliard, France
8 Clinique Saint-Vincent, Besançon, France
9 Centre Hospitalier de Bretagne Sud, Lorient, France
10 Centre Alexis Vautrin, Nancy, France

* To whom correspondence should be addressed.
P. Fumoleau, E-mail: pfumoleau{at}dijon.fnclcc.fr


  Abstract

Background: The aim of the study was to evaluate and compare incidence and risk factors of left ventricular dysfunction (LVD) in early breast cancer patients receiving (E+) or not (E-) epirubicin-based adjuvant chemotherapy.

Patients and methods: Among eight FASG trials, 3577 assessable patients were analyzed retrospectively: 2553 received epirubicin, 662 received hormonotherapy alone and 362 had no systemic treatment. Chemotherapy was FEC regimen in 86% of cases (fluorouracil, epirubicin, cyclophosphamide). Epirubicin cumulative dose was <300 mg/m2 in 1040 patients, 300-600 in 1155, ≥600 in 279, followed by radiotherapy in 96% of cases.

Results: Twenty delayed LVD occurred: two in E- patients and 18 in E+ patients. In E+ patients, 14 patients normalized their cardiac function or did not require further investigations, one patient was stabilized with specific treatment, two patients worsened their functions and one died of congestive heart failure. The 7-year risk of LVD was 1.36% (95% CI 0.85-1.87) in E+ patients and 0.21% (95%CI: 0.00-0.52) in E- patients (P = 0.004). Two significant risk factors were identified: age ≥65 years and body mass index >27 kg/m2.

Conclusion: After a long-term follow-up, epirubicin-related LVD risk was acceptable (1.36%) with one toxic death (0.04%). In 78% of cases, LVD were transient or well controlled.

Keywords: adjuvant chemotherapy; breast cancer; epirubicin; cardiotoxicity.
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