Subclinical cardiotoxicity following adjuvant dose-escalated FEC, high-dose chemotherapy, or CMF in breast cancer

• Published in: British journal of cancer Vol. 82; no. 4; pp. 777 - 781
• Main Authors: ERSELCAN, T, KAIREMO, K. J. A, WIKLUND, T. A, HERNBERG, M, BLOMQVIST, C. P, TENHUNEN, M, BERGH, J, JOENSUU, H
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.02.2000
• Subjects: Adult; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Breast Neoplasms - drug therapy; Breast Neoplasms - therapy; Chemotherapy, Adjuvant; Combined Modality Therapy; Cyclophosphamide - administration & dosage; Dose-Response Relationship, Drug; Drug toxicity and drugs side effects treatment; Epirubicin - administration & dosage; Female; Fluorouracil - administration & dosage; Heart - drug effects; Hematopoietic Stem Cell Transplantation; Humans; Medical sciences; Medicin och hälsovetenskap; Methotrexate - administration & dosage; Middle Aged; Pharmacology. Drug treatments; Regular; Toxicity: cardiovascular system; Radionuclide study; Antineoplastic agent; Cardiomyopathy; Toxicity; Adjuvant treatment; Contractile protein; Cardiovascular disease; Monoclonal antibody; Scintigraphy; Myocardial disease; Antifolate; Increasing dose; Heart disease; Myosin; Complication; Epirubicin; Mammary gland; Methotrexate; High dose; Fluorouracil; Human; Drug combination; Fluoropyrimidine derivatives; Malignant tumor; Mammary gland diseases; Alkylating agent; Chemotherapy; Cyclophosphamide; Oxazaphosphinane derivatives; Antimetabolic; Nitrogen mustard; Medical imagery; Pyrimidine derivatives; Anthracyclins; Fluorine Organic compounds; Therapeutic protocol; Comparative study
• ISSN: 0007-0920; 1532-1827
• DOI: 10.1054/bjoc.1999.0998

We compared adjuvant chemotherapy-related myocardial damage by antimyosin scintigraphy in patients who received either nine cycles of FEC (fluorouracil, epirubicin and cyclophosphamide) where the doses of epirubicin and cyclophosphamide were escalated according to the leucocyte nadir (group I, n = 14), three cycles of FEC followed by high-dose chemotherapy with alkylating agents (CTCb) given with the support of peripheral blood stem cell transplantation (group II, n = 14), or six cycles of standard intravenous CMF (cyclophosphamide, methotrexate and fluorouracil; group III, n = 8). The cardiac uptake of In-111-antimyosin-Fab (R11D10) antibody was measured and the heart-to-lung ratio (HLR) calculated 8-36 months after the last dose of chemotherapy. Cardiac antimyosin antibody uptake was considerably higher among patients treated with nine cycles of dose-escalated FEC than among those who were treated with three cycles of FEC and high-dose CTCb (HLR, median 1.98; range 1.36-2.24 vs median 1.51; range 1.20-1.82; P < 0.001), or those treated with CMF (median 1.44; range 1.15-1.68; P < 0.001). The difference between groups II and III was not significant (P > 0.1). A linear association was found between the cumulative dose of epirubicin and the cardiac antimyosin uptake (P < 0.001). We conclude that subclinical cardiac damage caused by three cycles of conventional-dose FEC followed by one cycle of high-dose CTCb chemotherapy is small as compared with the damage caused by dose-escalated FEC.