Anthracycline-induced cardiotoxicity in patients with early-stage breast cancer: the Canadian Cancer Trials Group (CCTG) MA.21 experience

摘要: Anthracyclines are frequently used in adjuvant treatment for early-stage breast cancer (ESBC). The purpose of this study was to evaluate cardiotoxic effects the first five years after with different anthracycline-based regimens. CCTG MA.21 (NCT000142) was a phase III trial ESBC that compared cyclophosphamide (75 mg/m2) orally 14 days, epirubicin (60 mg/m2) and fluorouracil, IV days one eight (CEF) six cycles; dose-dense (120 mg/m2) cyclophosphamide, every 2 weeks cycles concurrent G-CSF then paclitaxel four (ddEC/T); doxorubicin (60 mg/m2) (600 mg/m2) every 3 weeks q3 weekly (175 (AC/T). Endpoints: LVEF decline; LV function changes (heart failure), or Grade 3–4 cardiac ischemia/infarction. A competing risk analysis performed endpoints cardiotoxicity recurrence 5 years completion chemotherapy. 2104 women were randomized. Compliance assessments 70% at all arms. 5-year cumulative risks any event CEF, ddECT, AC/T 22.3% (95%CI 18.9 25.7), 14.2% 11.0 17.3), 8.1% 5.8 10.4), respectively, p < 0.0001. At 5 years, ddEC/T group had significantly lower than those given CEF (HR 0.599 0.371, respectively). Most events asymptomatic drop LVEF. Asymptomatic accounted most cardiotoxicity. majority occurred year although occurrence over time highlights need improved stratification guide surveillance strategies.