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Heart failure after treatment for breast cancer
Author(s) -
Boekel Naomi B.,
Duane Fran K.,
Jacobse Judy N.,
Hauptmann Michael,
Schaapveld Michael,
Sonke Gabe S.,
Gietema Jourik A.,
Hooning Maartje J.,
Seynaeve Caroline M.,
Maas Angela H.E.M.,
Darby Sarah C.,
Aleman Berthe M.P.,
Taylor Carolyn W.,
Leeuwen Flora E.
Publication year - 2020
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.1620
Subject(s) - medicine , trastuzumab , anthracycline , breast cancer , interquartile range , radiation therapy , heart failure , cumulative dose , oncology , hazard ratio , confidence interval , cancer , cardiology
Background We aimed to develop dose–response relationships for heart failure (HF) following radiation and anthracyclines in breast cancer treatment, and to assess HF associations with trastuzumab and endocrine therapies. Methods and results A case–control study was performed within a cohort of breast cancer survivors treated during 1980–2009. Cases ( n = 102) had HF as first cardiovascular diagnosis and were matched 1:3 on age and date of diagnosis. Individual cardiac radiation doses were estimated, and anthracycline doses and use of trastuzumab and endocrine therapy were abstracted from oncology notes. For HF cases who received radiotherapy, the estimated median mean heart dose (MHD) was 6.8 Gy [interquartile range (IQR) 0.9–13.7]. MHD was not associated with HF risk overall [excess rate ratio (ERR) = 1%/Gy, 95% confidence interval (CI) −2 to 10]. In patients treated with anthracyclines, exposure of ≥20% of the heart to ≥20 Gy was associated with a rate ratio of 5.7 (95% CI 1.7–21.7) compared to <10% exposed to ≥20 Gy. For cases who received radiotherapy, median cumulative anthracycline dose was 247 mg/m 2 (IQR 240–319). A dose‐dependent increase was observed after anthracycline without trastuzumab (ERR = 1.5% per mg/m 2 , 95% CI 0.5–4.1). After anthracycline and trastuzumab, the rate ratio was 34.9 (95% CI 11.1–110.1) compared to no chemotherapy. Conclusions In absence of anthracyclines, breast cancer radiotherapy was not associated with increased HF risk. Strongly elevated HF risks were observed after treatment with anthracyclines and also after treatment with trastuzumab. The benefits of these systemic treatments usually exceed the risks of HF, but our results emphasize the need to support ongoing efforts to evaluate preventative strategies.