Long‐term effect of epirubicin on incidence of heart failure in women with breast cancer: insight from a randomized clinical trial

Banke, Ann; Fosbøl, Emil Loldrup; Møller, Jacob Eifer; Gislason, Gunnar; Andersen, Mads; Bernsdorf, Mogens; Jensen, Maj Britt; Schou, Morten; Ejlertsen, Bent

doi:10.1002/ejhf.1168

Cited by 56 publications

(52 citation statements)

References 25 publications

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“…At this later follow‐up, the authors identified six additional (32 total) cases of symptomatic HF corresponding to a low incidence of symptomatic HF at 3.7 per 1000 patient‐years in the epirubicin arm, which was higher than the incidence of 1.4 per 1000 patient‐years in the control arm. The authors conclude that the number needed to harm to cause one additional case of symptomatic HF was 29, which was nearly twice as high as the number needed to treat of 18 to save one life with epirubicin therapy . Consistent with the original DBCG 89D trial publication in 2007 6 of improved breast cancer survival with epirubicin‐based chemotherapy regimens, the relatively low observed long‐term incidence of symptomatic HF associated with epirubicin will therefore be reassuring to both patients and clinicians.…”

Section: Twenty Years Later: the Danish Breast Cancer Cooperative Gromentioning

confidence: 74%

“…In this issue of the Journal, Banke and colleagues undertake an exploratory analysis of the DBCG 89D cohort after an additional 5 years of follow‐up (median follow‐up now of 17 years) . At this later follow‐up, the authors identified six additional (32 total) cases of symptomatic HF corresponding to a low incidence of symptomatic HF at 3.7 per 1000 patient‐years in the epirubicin arm, which was higher than the incidence of 1.4 per 1000 patient‐years in the control arm.…”

Section: Twenty Years Later: the Danish Breast Cancer Cooperative Gromentioning

confidence: 99%

“…The original DBCG 89D trial did not include protocolized cardiac imaging for HF surveillance and instead relied upon investigator‐reported signs and symptoms, which were not different between study arms . Banke et al . leveraged International Classification of Diseases and Related Health Problems (ICD)‐based Danish national registries to retrospectively identify Danish participants of DBCG 89D who experienced symptomatic HF.…”

Section: The Tip Of the Icebergmentioning

confidence: 99%

See 2 more Smart Citations

Epirubicin and long‐term heart failure risk in breast cancer survivors

Mahmood

Patel

Butler

et al. 2018

European J of Heart Fail

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Section: Twenty Years Later: the Danish Breast Cancer Cooperative Gromentioning

confidence: 74%

Section: Twenty Years Later: the Danish Breast Cancer Cooperative Gromentioning

confidence: 99%

Section: The Tip Of the Icebergmentioning

confidence: 99%

See 1 more Smart Citation

Epirubicin and long‐term heart failure risk in breast cancer survivors

Mahmood

Patel

Butler

et al. 2018

European J of Heart Fail

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“…[202][203][204][205] , It is well-established that frailty has a key role in HF. 210 The incidence of cardiotoxicity for anthracyclines, anti-human epidermal growth factor receptor (HER2) agents and tyrosine kinase inhibitors were 75.8%, 69.8%, and 61.1%, respectively in a large cardio-oncology service. Similar to the results in the patients with HFrEF, frailty was very common also among patients with HFpEF, and it was associated with higher risk of cardiovascular outcomes and mortality in TOPCAT.…”

Section: Comorbiditiesmentioning

confidence: 99%

Highlights in heart failure

et al. 2019

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Heart failure (HF) remains a major cause of mortality, morbidity, and poor quality of life. It is an area of active research. This article is aimed to give an update on recent advances in all aspects of this syndrome. Major changes occurred in drug treatment of HF with reduced ejection fraction (HFrEF). Sacubitril/valsartan is indicated as a substitute to ACEi/ARBs after PARADIGM-HF (hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.73 to 0.87 for sacubitril/valsartan vs. enalapril for the primary endpoint and Wei, Lin and Weissfeld HR 0.79, 95% CI 0.71-0.89 for recurrent events). Its initiation was then shown as safe and potentially useful in studies in patients hospitalized for acute HF. More recently, DAPA-HF trial showed the beneficial effects of the sodium-glucose transporter type 2 (SGLT2) inhibitor dapaglifozin vs. placebo, added to optimal standard therapy [HR, 0.74; 95% CI, 0.65 to 0.85;0.74; 95% CI, 0.65 to 0.85 for the primary endpoint]. Trials with other SGLT 2 inhibitors and in other patients, such as those with HF with preserved ejection fraction (HFpEF) or with recent decompensation, are ongoing. Multiple studies showed the unfavourable prognostic significance of abnormalities in serum potassium levels. Potassium lowering agents may allow initiation and titration of mineralocorticoid antagonists in a larger proportion of patients. Meta-analyses suggest better outcomes with ferric carboxymaltose in patients with iron deficiency. Drugs effective in HFrEF may be useful also in HF with mid-range ejection fraction. Better diagnosis and phenotype characterization seem warranted in HF with preserved ejection fraction. These and other burning aspects of HFpEF research are summarized and reviewed in this article.A multiparametric approach is often proposed for risk stratification of HF patients. The prognostic accuracy of the metabolic exercise test data combined with cardiac and kidney indexes risk score was found as superior to the HF Survival Score and Seattle HF model risk scores in a cohort of 6112 1106 D. Tomasoni et al.

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“…The long‐term effects of anthracycline therapy are controversial and based on observational studies. Banke et al . report on the long‐term effects of epirubicin administration in 980 women enrolled between 1990 and 1998 in the Danish Breast Cancer Cooperative Group (DBCG) 89D trial.…”

Section: Cardio‐oncology: Epirubicin Long‐term Cardiotoxicitymentioning

confidence: 99%