Long-term cardiovascular disease risk after anthracycline and trastuzumab treatments in US breast cancer survivors.

Autor:	Vo JB; Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA., Ramin C; Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.; Department of Biomedical Sciences, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA., Veiga LHS; Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA., Brandt C; Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA., Curtis RE; Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA., Bodelon C; Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.; Population Science Department, American Cancer Society, Atlanta, GA, USA., Barac A; Inova Schar Cancer, Inova Schar Heart and Vascular, Fairfax, VA, USA., Roger VL; Epidemiology and Community Health Branch, National Heart, Lung, and Blood Institute, Bethesda, MD, USA., Feigelson HS; Institute for Health Research, Kaiser Permanente, Denver, CO, USA.; Bernard J. Tyson Kaiser Permanente School of Medicine, Pasadena, CA, USA., Buist DSM; Bernard J. Tyson Kaiser Permanente School of Medicine, Pasadena, CA, USA.; Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA., Bowles EJA; Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA., Gierach GL; Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA., Berrington de González A; Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.; Clinical Cancer Epidemiology Group, Institute for Cancer Research, London, UK.
Jazyk:	angličtina
Zdroj:	Journal of the National Cancer Institute [J Natl Cancer Inst] 2024 Aug 01; Vol. 116 (8), pp. 1384-1394.
DOI:	10.1093/jnci/djae107
Abstrakt:	Background: Although breast cancer survivors are at risk for cardiovascular disease (CVD) from treatment late effects, evidence to inform long-term and age-specific cardiovascular surveillance recommendations is lacking. Methods: We conducted a retrospective cohort study of 10 211 women diagnosed with first primary unilateral breast cancer in Kaiser Permanente Washington or Colorado (aged 20 years and older, survived ≥1 year). We estimated multivariable adjusted hazard ratios (HRs) for associations between initial chemotherapy regimen type (anthracycline and/or trastuzumab, other chemotherapies, no chemotherapy [referent]) and CVD risk, adjusted for patient characteristics, other treatments, and CVD risk factors. Cumulative incidence was calculated considering competing events. Results: After 5.79 median years, 14.67% of women developed CVD (cardiomyopathy and/or heart failure [HF], ischemic heart disease, stroke). Women treated with anthracyclines and/or trastuzumab had a higher risk of CVD compared with no chemotherapy (adjusted HR = 1.53, 95% confidence interval [CI] = 1.31 to 1.79), persisting at least 5 years postdiagnosis (adjusted HR5-<10 years = 1.85, 95% CI = 1.44 to 2.39; adjusted HR≥10 years = 1.83, 95% CI = 1.34 to 2.49). Cardiomyopathy and/or HF risks were elevated among women treated with anthracyclines and/or trastuzumab compared with no chemotherapy, especially for those aged younger than 65 years (adjusted HR20-54years = 2.97, 95% CI = 1.72 to 5.12; adjusted HR55-64years = 2.21, 95% CI = 1.52 to 3.21), differing for older women (adjusted HR≥65 years = 1.32, 95% CI = 0.97 to 1.78), and at least 5 years postdiagnosis (adjusted HR5-<10years = 1.89, 95% CI = 1.35 to 2.64; adjusted HR≥10 years = 2.21, 95% CI = 1.52 to 3.20). Anthracyclines and/or trastuzumab receipt was associated with increased ischemic heart disease risks after 5 or more years (adjusted HR5-<10years = 1.51, 95% CI = 1.06 to 2.14; adjusted HR≥10 years = 1.86, 95% CI = 1.18 to 2.93) with no clear age effects, and stroke risk (adjusted HR = 1.33, 95% CI = 1.05 to 1.69), which did not vary by time or age. There was some evidence of long-term cardiomyopathy and/or HF and ischemic heart disease risks with other chemotherapies. Among women aged younger than 65 treated with anthracyclines and/or trastuzumab, up to 16% developed CVD by 10 years (20-54 years = 6.91%; 55-64 years = 16.00%), driven by cardiomyopathy and/or HF (20-54 years = 3.90%; 55-64 years = 9.78%). Conclusions: We found increased long-term risks of cardiomyopathy and/or HF and ischemic heart disease among breast cancer survivors treated with anthracyclines and/or trastuzumab and increased cardiomyopathy and/or HF risk among women aged younger than 65 years. (Published by Oxford University Press 2024.)
Databáze:	MEDLINE
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