Abstract P3-15-04: The Clinical Course of Metastatic Breast Cancer Patients with a Congestive Heart Failure after an Epirubicin-Based Treatment

Abstract

Abstract Background. Patients treated with epirubicin are at risk for the development of congestive heart failure (CHF). However, only limited data are available, which is describing the outcome for these patients. Materials and methods. The patients were recruited consecutively from 1,097 anthracycline-naïve patients with metastatic breast cancer, who were admitted to Herlev Hospital from November 1983 - November 2003 for an epirubicin-based chemotherapy. No patients had a history of heart disease. The outcome of 125 metastatic breast cancer patients, with a CHF Class ≥ II according to New York Heart Association (NYHA) guidelines after an epirubicin-based treatment, was performed retrospectively. Univariate ordinal logistic regression was used to study the association between NYHA class at time of CHF (II, III or IV) and possible risk factors. Two multiple Cox regression analyses (events: mortality of cardiotoxicity and mortality of other causes) were performed to evaluate the risk of cardiac death. Results. CHF was developed within a median time from cessation of epirubicin on 3 months (range 0 to 66.7 months). The distribution of patients in the NYHA class II, III, IV and NYHA class ≥2 was; 35 patients (28%), 38 patients (30.4%), 39 patients (31.2%) and 13 patients (10.4%), respectively. No predictive factors, including increasing cumulative dose of epirubicin, co-morbidities and age had an influence on the severity of CHF. The median survival of all patients was 7.3 months (range 0.01 to +121.1 months). Deaths caused by CHF occurred in 27 patients (21.6%) in a median time on 1.2 months (range 0 - 77 months), including 6 patients (4.8%) dying of cardiac failure < 10 days after the diagnosis. Only the NYHA class patient had was the only risk factor for dying of CHF (p = 0.0003). Compared to patients in NYHA class II and III, the risk of cardiac death in patients with NYHA class IV was increased with 93% and 74%, respectively. Survival in patients with stable CHF was comparable to other patients with metastatic breast cancer. Discussion. Although the information is obtained retrospectively during a period of twenty years; the study is important, as only limited information is available on the course of CHF patients. The study showed that the risk of cardiac death were closely related to the degree of cardiac toxicity as the risk of cardiac death was 93% or 74% higher for patients in NYHA class IV than for patients in NYHA class II or III. Moreover, the outcome for the patients when CHF is stabilized can be expected to be as patients without CHF. Furthermore, no predictive factors were identified, including increasing cumulative dose of epirubicin for the severity of cardiotoxicity developed. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P3-15-04.