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Long‐term cardiac safety and outcomes of dose‐dense doxorubicin and cyclophosphamide followed by paclitaxel and trastuzumab with and without lapatinib in patients with early breast cancer
Author(s) -
Morris Patrick G.,
Iyengar Neil M.,
Patil Sujata,
Chen Carol,
Abbruzzi Alyson,
Lehman Robert,
Steingart Richard,
Oeffinger Kevin C.,
Lin Nancy,
Moy Beverley,
Come Steven E.,
Winer Eric P.,
Norton Larry,
Hudis Clifford A.,
Dang Chau T.
Publication year - 2013
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.28284
Subject(s) - medicine , lapatinib , trastuzumab , breast cancer , cumulative incidence , cyclophosphamide , ejection fraction , oncology , heart failure , cancer , paclitaxel , confidence interval , chemotherapy , cumulative dose , surgery , transplantation
BACKGROUND The authors have previously reported 2 consecutive phase 2 trials in patients with early breast cancer that overexpresses human epidermal growth factor receptor 2 ( HER2 ) to assess the feasibility of incorporating anti‐HER2 therapies into dose‐dense (dd) chemotherapy regimens. The incidence of congestive heart failure (CHF) at a median follow‐up of 2 years was 1.4% and 3.2%, respectively. METHODS In trial A, patients received dd doxorubicin and cyclophosphamide (AC)→paclitaxel (T) (each given every 2 weeks) × 4 with trastuzumab (H) given × 1 year. In trial B, weekly T (weekly × 12) was substituted for ddT and lapatinib × 1 year was added. Herein, the authors report the longer‐term incidence of CHF and distant disease‐free survival (DDFS). RESULTS From January 2005 to May 2008, 165 patients enrolled (median age, 46 years, with a median left ventricular ejection fraction of 68% [range, 52%‐81%]), 17%of whom had previous hypertension. With a median follow‐up of 84 months (trial A) and 57 months (trial B), 1 additional patient developed CHF. Therefore, the cumulative incidence of CHF was 1.4% (95% confidence interval [95% CI], 1.36%‐7.7%) for trial A and 4.2% (95% CI, 4.2%‐10.4%) for trial B. The 5‐year DDFS for trials A and B was 92% (95% CI, 83%‐97%) and 89% (95% CI, 81%‐94%), respectively. CONCLUSIONS Longer follow‐up of these 2 studies has demonstrated that ddAC→TH only or with lapatinib is associated with a low risk of CHF and promising DDFS in patients with early breast cancer. Cancer 2013 ;119:3943–3951. © 2013 American Cancer Society .