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Breast Cancer Research and Treatment

, Volume 171, Issue 1, pp 181–188 | Cite as

Incidence and risk factors for congestive heart failure in patients with early breast cancer who received anthracycline and/or trastuzumab: a big data analysis of the Korean Health Insurance Review and Assessment service database

  • Jung Yoon Choi
  • Eun Young Cho
  • Yoon Ji Choi
  • Jeong Hyeon Lee
  • Seung Pil Jung
  • Kyu Ran Cho
  • Chul Yong Kim
  • Yeul Hong Kim
  • Kyong Hwa Park
Epidemiology

Abstract

Purpose

We aimed to analyze the incidence, time to occurrence, and congestive heart failure (CHF) risk factors for early breast cancer patients treated with anthracycline (AC)-based chemotherapy and/or trastuzumab (T) therapy in Korea.

Methods

We included female patients > 19 years old from the Health Insurance Review and Assessment Service database who had no prior CHF history and had been diagnosed with early breast cancer between January 2007 and October 2016.

Results

We included 83,544 patients in our analysis. In terms of crude incidence for CHF, AC followed by T showed the highest incidence (6.3%). However, 3.1 and 4.2% of the patients had CHF due to AC-based chemotherapy and non-AC followed by T, respectively. The median times to occurrence of CHF were different according to adjuvant treatments, approximately 2 years (701.0 days) in the AC-based chemotherapy group vs 1 year (377.5 days) AC followed by T group. T therapy was associated with earlier development of CHF irrespective of previous chemotherapy, but late risk of CHF 1.2 years after T therapy rapidly decreased in both chemotherapy groups. Multivariate Cox regression analysis revealed that the adjusted hazard ratio for CHF was increased in the group of older patients (≥ 65 years old) who underwent AC followed by T therapy, with Charlson comorbidity index scores of ≥ 2.

Conclusions

Our study showed that neo-/adjuvant chemotherapy using T irrespective of previous chemotherapy (AC or non-AC) was associated with significantly increased risk of CHF compared with AC-based chemotherapy in Korean patients with early breast cancer.

Keywords

Congestive heart failure Anthracycline Trastuzumab Breast cancer 

Notes

Acknowledgements

The authors thank the support of Korea University Anam Hospital Clinical Trial Center.

Funding

This study was funded by a Grant of the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (HI14C2750).

Compliance with ethical standards

Conflict of interest

The authors indicated no potential conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

The institutional review board of Korea University Anam Hospital approved and granted this study a waiver of informed consents from participants.

Supplementary material

10549_2018_4809_MOESM1_ESM.docx (40 kb)
Supplementary material 1 (DOCX 40 KB)

References

  1. 1.
    Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2005) Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 365:1687–1717.  https://doi.org/10.1016/s0140-6736(05)66544-0 CrossRefGoogle Scholar
  2. 2.
    Moja L, Tagliabue L, Balduzzi S, Parmelli E, Pistotti V, Guarneri V, D’Amico R (2012) Trastuzumab containing regimens for early breast cancer. Cochrane Database Syst Rev.  https://doi.org/10.1002/14651858.CD006243.pub2 Google Scholar
  3. 3.
    Volkova M, Russell R (2011) Anthracycline cardiotoxicity: prevalence, pathogenesis and treatment. Curr Cardiol Rev 7:214–220CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Minow RA, Benjamin RS, Lee ET, Gottlieb JA (1977) Adriamycin cardiomyopathy–risk factors. Cancer 39:1397–1402CrossRefPubMedGoogle Scholar
  5. 5.
    Von Hoff DD, Layard MW, Basa P, Davis HL, Jr., Von Hoff AL, Rozencweig M, Muggia FM (1979) Risk factors for doxorubicin-induced congestive heart failure. Ann Intern Med 91:710–717CrossRefGoogle Scholar
  6. 6.
    Chien HC, Kao Yang YH, Bai JP (2016) Trastuzumab-related cardiotoxic effects in Taiwanese women: a nationwide cohort study. JAMA Oncol 2:1317–1325.  https://doi.org/10.1001/jamaoncol.2016.1269 CrossRefPubMedGoogle Scholar
  7. 7.
    Romond EH, Perez EA, Bryant J, Suman VJ, Geyer CE Jr, Davidson NE, Tan-Chiu E, Martino S, Paik S, Kaufman PA, Swain SM, Pisansky TM, Fehrenbacher L, Kutteh LA, Vogel VG, Visscher DW, Yothers G, Jenkins RB, Brown AM, Dakhil SR, Mamounas EP, Lingle WL, Klein PM, Ingle JN, Wolmark N (2005) Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. N Engl J Med 353:1673–1684.  https://doi.org/10.1056/NEJMoa052122 CrossRefPubMedGoogle Scholar
  8. 8.
    Swain SM, Whaley FS, Ewer MS (2003) Congestive heart failure in patients treated with doxorubicin: a retrospective analysis of three trials. Cancer 97:2869–2879.  https://doi.org/10.1002/cncr.11407 CrossRefPubMedGoogle Scholar
  9. 9.
    Piccart-Gebhart MJ, Procter M, Leyland-Jones B, Goldhirsch A, Untch M, Smith I, Gianni L, Baselga J, Bell R, Jackisch C, Cameron D, Dowsett M, Barrios CH, Steger G, Huang CS, Andersson M, Inbar M, Lichinitser M, Lang I, Nitz U, Iwata H, Thomssen C, Lohrisch C, Suter TM, Ruschoff J, Suto T, Greatorex V, Ward C, Straehle C, McFadden E, Dolci MS, Gelber RD (2005) Trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer. N Engl J Med 353:1659–1672.  https://doi.org/10.1056/NEJMoa052306 CrossRefPubMedGoogle Scholar
  10. 10.
    Pinder MC, Duan Z, Goodwin JS, Hortobagyi GN, Giordano SH (2007) Congestive heart failure in older women treated with adjuvant anthracycline chemotherapy for breast cancer. J Clin Oncol 25:3808–3815.  https://doi.org/10.1200/JCO.2006.10.4976.6 CrossRefPubMedGoogle Scholar
  11. 11.
    Youlden DR, Cramb SM, Yip CH, Baade PD (2014) Incidence and mortality of female breast cancer in the Asia-Pacific region. Cancer Biol Med 11:101–115.  https://doi.org/10.7497/j.issn.2095-3941.2014.02.005 PubMedPubMedCentralGoogle Scholar
  12. 12.
    Sundararajan V, Henderson T, Perry C, Muggivan A, Quan H, Ghali WA (2004) New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality. J Clin Epidemiol 57:1288–1294.  https://doi.org/10.1016/j.jclinepi.2004.03.012 CrossRefPubMedGoogle Scholar
  13. 13.
    Goldhar HA, Yan AT, Ko DT, Earle CC, Tomlinson GA, Trudeau ME, Krahn MD, Krzyzanowska MK, Pal RS, Brezden-Masley C, Gavura S, Lien K, Chan KK (2016) The temporal risk of heart failure associated with adjuvant trastuzumab in breast cancer patients: a population study. J Natl Cancer Inst 108:djv301.  https://doi.org/10.1093/jnci/djv301 CrossRefPubMedGoogle Scholar
  14. 14.
    Bowles EJ, Wellman R, Feigelson HS, Onitilo AA, Freedman AN, Delate T, Allen LA, Nekhlyudov L, Goddard KA, Davis RL, Habel LA, Yood MU, McCarty C, Magid DJ, Wagner EH (2012) Risk of heart failure in breast cancer patients after anthracycline and trastuzumab treatment: a retrospective cohort study. J Natl Cancer Inst 104:1293–1305.  https://doi.org/10.1093/jnci/djs317 CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Perez EA, Romond EH, Suman VJ, Jeong JH, Davidson NE, Geyer CE Jr, Martino S, Mamounas EP, Kaufman PA, Wolmark N (2011) Four-year follow-up of trastuzumab plus adjuvant chemotherapy for operable human epidermal growth factor receptor 2-positive breast cancer: joint analysis of data from NCCTG N9831 and NSABP B-31. J Clin Oncol 29:3366–3373.  https://doi.org/10.1200/jco.2011.35.0868 CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Slamon D, Eiermann W, Robert N, Pienkowski T, Martin M, Press M, Mackey J, Glaspy J, Chan A, Pawlicki M, Pinter T, Valero V, Liu MC, Sauter G, von Minckwitz G, Visco F, Bee V, Buyse M, Bendahmane B, Tabah-Fisch I, Lindsay MA, Riva A, Crown J (2011) Adjuvant trastuzumab in HER2-positive breast cancer. N Engl J Med 365:1273–1283.  https://doi.org/10.1056/NEJMoa0910383 CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Viani GA, Afonso SL, Stefano EJ, De Fendi LI, Soares FV (2007) Adjuvant trastuzumab in the treatment of her-2-positive early breast cancer: a meta-analysis of published randomized trials. BMC Cancer 7:153.  https://doi.org/10.1186/1471-2407-7-153 CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Chien AJ, Rugo HS (2010) The cardiac safety of trastuzumab in the treatment of breast cancer. Expert Opin Drug Saf 9:335–346.  https://doi.org/10.1517/14740331003627441 CrossRefPubMedGoogle Scholar
  19. 19.
    Gianni L, Salvatorelli E, Minotti G (2007) Anthracycline cardiotoxicity in breast cancer patients: synergism with trastuzumab and taxanes. Cardiovasc Toxicol 7:67–71.  https://doi.org/10.1007/s12012-007-0013-5 CrossRefPubMedGoogle Scholar
  20. 20.
    Yu AF, Mukku RB, Verma S, Liu JE, Oeffinger KC, Steingart RM, Hudis CA, Dang CT (2017) Cardiac safety of non-anthracycline trastuzumab-based therapy for HER2-positive breast cancer. Breast Cancer Res Treat 166:241–247.  https://doi.org/10.1007/s10549-017-4362-x CrossRefPubMedGoogle Scholar
  21. 21.
    Sakata Y, Shimokawa H (2013) Epidemiology of heart failure in Asia. Circ J 77:2209–2217CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Jung Yoon Choi
    • 1
  • Eun Young Cho
    • 2
  • Yoon Ji Choi
    • 1
  • Jeong Hyeon Lee
    • 3
  • Seung Pil Jung
    • 4
  • Kyu Ran Cho
    • 5
  • Chul Yong Kim
    • 6
  • Yeul Hong Kim
    • 1
  • Kyong Hwa Park
    • 1
  1. 1.Division of Oncology, Department of Internal MedicineKorea University Anam Hospital, Korea University College of MedicineSeoulRepublic of Korea
  2. 2.Department of BiostatisticsKorea University Anam Hospital, Korea University College of MedicineSeoulRepublic of Korea
  3. 3.Department of PathologyKorea University Anam Hospital, Korea University College of MedicineSeoulRepublic of Korea
  4. 4.Department of General SurgeryKorea University Anam Hospital, Korea University College of MedicineSeoulRepublic of Korea
  5. 5.Department of RadiologyKorea University Anam Hospital, Korea University College of MedicineSeoulRepublic of Korea
  6. 6.Department of Radiation OncologyKorea University Anam Hospital, Korea University College of MedicineSeoulRepublic of Korea

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