Docetaxel with epirubicin—investigations on cardiac safety

Salminen, Eeva; Syvänen, Kari; Korpela, Jukka; Varpula, Marjut; Antila, K.; Varjo, P.; Ekholm, Eeva

doi:10.1097/00001813-200301000-00010

Cited by 15 publications

(5 citation statements)

References 24 publications

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“…A decline in HRV denotes impaired cardiac autonomic activity with sympathovagal imbalance. Consistent with previous findings that have shown damaged cardiac sympathovagal balance by anthracyclines, [29][30][31] our present study also revealed that patients in the TAU groups exhibited reduced HRV after epirubicin treatment, suggesting that epirubicin impaired cardiac ANS activity. However, this decrease was prevented in TAUYT group patients, suggesting that yoga improved the epirubicin-induced ANS dysfunction.…”

Section: Discussionsupporting

confidence: 93%

Effects of an 18-Week Integrated Yoga Program on Cardiac Autonomic Function in Breast Cancer Patients Undergoing Adjuvant Chemotherapy: A Randomized Controlled Trial

Inbaraj,

Udupa,

Raghavendra

et al. 2023

Integr Cancer Ther

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Background: Cardiotoxicity is a commonly observed adverse effect seen in breast cancer (BC) patients undergoing chemotherapy with attributes toward cardiac autonomic dysfunction (CAD). Yoga, a mind-body system of medicine that has been shown to improve cardiac autonomic nervous system (ANS) activity in various health conditions, could be an effective adjuvant approach in addressing CAD. Objective: This study aims to investigate the protective effects of Integrated Yoga Therapy (IYT) on ANS functioning, assessed using Heart rate variability (HRV) in breast cancer patients undergoing chemotherapy. Methods: A total of 68 (stage I-III) BC patients were randomly assigned into 2 groups: Treatment as Usual group (TAU) and TAU with Yoga Therapy group (TAUYT). All patients underwent anthracycline-based adjuvant chemotherapy for a total of 6 cycles with 21 days/cycle. During chemotherapy, the TAUYT group received IYT 5 days a week for 18 weeks, compared with usual care alone in the TAU group. Resting heart rate (RHR) and HRV, measured in both the time and frequency domains, were used to assess the cardiac ANS function of each patient before and after 6 cycles of chemotherapy. Results: A total of 30 subjects in the TAU group and 29 subjects in the TAUYT group were included in the analysis. At baseline (before chemotherapy), there were no significant differences between the TAU and TAUYT groups in terms of RHR and HRV indices. However, after chemotherapy, patients in the TAU group had a significantly higher average RHR ( P < .02) and lower HRV indices with reduced parasympathetic indices: RMSSD ( P < .01), pNN50% ( P < .04), high-frequency power ( P < .001) and increased sympathetic indices: low-frequency power ( P < .001) with sympathovagal imbalance: LF/HF ( P < .001) compared with patients in the TAUYT group. Conclusion: The study showed the protective effects of yoga therapy on CAD in patients receiving anthracycline-based chemotherapy for BC, proposing yoga as a potential adjuvant intervention in improving cardiac health and preventing cardiovascular-related morbidities. Trial Registration: This trial is registered with the Clinical Trials Registry-India (CTRI) database (CTRI/2020/10/028446; October 16, 2020).

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Section: Discussionsupporting

confidence: 93%

Effects of an 18-Week Integrated Yoga Program on Cardiac Autonomic Function in Breast Cancer Patients Undergoing Adjuvant Chemotherapy: A Randomized Controlled Trial

Inbaraj,

Udupa,

Raghavendra

et al. 2023

Integr Cancer Ther

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“…Previously, we have reported the efficacy, toxicity and cost of treatment with the combination of epirubicin and docetaxel in metastatic breast cancer [10][11][12]. This report assessed the short-term quality of life outcome.…”

Section: Introductionmentioning

confidence: 99%

Quality of Life of Patients with Metastatic Breast Cancer Treated with Epirubicin and Docetaxel

Korpela¹,

Mali²,

Kaljonen³

et al. 2011

IJCM

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This phase II study assessed the clinical response and short-term quality of life of patients receiving first-line chemotherapy with epirubicin-docetaxel combination for metastatic breast cancer. Thirty-one breast cancer patients were treated with epirubicin (75 mg/m<sup>2</sup> for 15 minutes) followed one hour later by a one-hour infusion of docetaxel (75 mg/m<sup>2</sup>) q3w. EORTC QLQ-C30 and EORTC QLQ-BR23 forms were filled in at baseline, and at the second and eighth cycle of chemotherapy. The combination of epirubicin and docetaxel provided a high degree of clinical benefit. Clinical response was observed in 17 patients (55%), including five (16%) complete responses and 12 (39%) partial responses. Of responding and stable patients 23 (74%) maintained the same status for at least six months (clinical benefit). The mean survival time was 40.8 months. During the treatment the emotional functioning improved and the concerns about the future were relieved. Some aspects of quality of life were impaired, with slightly decreased physical and cognitive functioning, distress related to body image and hair loss, and adverse effects of chemotherapy. Overall, the global quality of life was maintained

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“…However, the previous study reported that the paclitaxel and doxorubicin combination had a higher incidence of cardiac failure. In this respect, it seems to be safe to use doxorubicin or EPI in combination with DTX [5,[8][9][10] . Although the number of therapy courses was small, our study showed no DTX-induced fluid retention and deformity of nails at any dose level.…”

Section: Discussionmentioning

confidence: 99%

“…Holmes et al [4] reported that sequencedependent alteration in doxorubicin clearance by paclitaxel caused increased myocardial damage. In contrast, in an anthracycline/docetaxel (DTX) combination, DTX did not appear to increase the incidence or severity of doxorubicin-associated cardiotoxitcity as compared with doxorubicin alone [5] .…”

mentioning

confidence: 91%

Dose Escalation Study of Epirubicin and Docetaxel in Patients with Advanced or Recurrent Breast Cancer

Ichinose

Hamada²,

Mitsuyama³

et al. 2008

Chemotherapy

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Background: Anthracyclines and taxanes are major cytotoxic drugs against breast cancer. To develop a combination of epirubicin (EPI) and docetaxel (DTX) in Japan, dose escalation and pharmacokinetic studies were performed in patients with advanced or recurrent breast cancer. Methods: Twenty patients received EPI (40, 50 or 60 mg/m²) as 5-min intravenous infusion, followed by DTX infusion (50 or 60 mg/m²) over 1 h in cohorts of 3–6 patients. The maximum tolerated dose (MTD) was defined during the first cycle when more than 2 of 3 or 3 of 6 patients suffered a dose-limiting toxicity (DLT). The DLT was based on febrile neutropenia (FN), prolonged neutropenia, thrombocytopenia and grade 3–4 nonhematological toxicity during the first cycle. Plasma sampling was performed to assess the pharmacokinetic study of these drugs. Results: The second level (EPI/DTX 50/50 mg/m²) was found to be a maximum tolerated dose because of a short duration of FN with no distress. Subsequently, the protocol was modified to permit a new DLT definition including FN lasting for more than 72 h. At the following levels of EPI/DTX 50/50, 50/60 or 60/60 mg/m², the dose escalation study revealed a high incidence of grade 4 neutropenia (100%) and FN (67%), which did not reach DLT. However, the safety committee decided not to go further because of too high an incidence of FN lasting 3 days, although a little less than 72 h. The pharmacokinetic study with a combination of EPI and DTX showed comparable blood levels of DTX and EPI in relation to those seen when given alone. Conclusion: For further evaluation, the recommended dose and schedule of this combination is EPI 60 mg/m² and DTX 60 mg/m², given every 3 weeks to patients without prior chemotherapy and EPI 50 mg/m² and DTX 50 mg/m² given to patients with prior chemotherapy, respectively. The pharmacokinetic study indicates no interaction between EPI and DTX.

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Docetaxel with epirubicin—investigations on cardiac safety

Cited by 15 publications

References 24 publications

Effects of an 18-Week Integrated Yoga Program on Cardiac Autonomic Function in Breast Cancer Patients Undergoing Adjuvant Chemotherapy: A Randomized Controlled Trial

Effects of an 18-Week Integrated Yoga Program on Cardiac Autonomic Function in Breast Cancer Patients Undergoing Adjuvant Chemotherapy: A Randomized Controlled Trial

Quality of Life of Patients with Metastatic Breast Cancer Treated with Epirubicin and Docetaxel

Dose Escalation Study of Epirubicin and Docetaxel in Patients with Advanced or Recurrent Breast Cancer

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