Cardiac sequelae of doxorubicin and paclitaxel as induction chemotherapy prior to high-dose chemotherapy and peripheral blood progenitor cell transplantation in women with high-risk primary or metastatic breast cancer

被引:9
作者
Klein, JL [1 ]
Rey, PM [1 ]
Dansey, RD [1 ]
Karanes, C [1 ]
Du, W [1 ]
Abella, E [1 ]
Cassells, L [1 ]
Hamm, C [1 ]
Peters, WP [1 ]
Baynes, RD [1 ]
机构
[1] Wayne State Univ, Sch Med, Div Hematol & Oncol, Barbara Ann Karmanos Canc Ctr, Detroit, MI 48201 USA
关键词
autologous; transplantation; breast cancer; doxorubicin; cardiotoxicity;
D O I
10.1038/sj.bmt.1702394
中图分类号
Q6 [生物物理学];
学科分类号
071011 ;
摘要
Doxorubicin plus paclitaxel has been shown to be an active regimen for metastatic breast cancer and is now frequently used as adjuvant therapy for high-risk primary breast cancer. Initial studies reported a higher than expected rate of cardiac toxicity with this regimen, We studied 105 patients with either high-risk primary breast cancer or metastatic breast cancer who were treated with doxorubicin (60 mg/m(2)) and 3-h infusions of paclitaxel (175 mg/m(2)) cycled every 3 weeks, Patients received three cycles of chemotherapy for high-risk primary or four cycles for metastatic disease. Patients then proceeded to high-dose chemotherapy (HDC) (STAMP I cyclophosphamide, cisplatin and carmustine) and peripheral blood progenitor cell transplantation (PBPCT), Patients underwent radionuclide multi-gated angiograms (MUGA) before and following induction chemotherapy and following HDC. During induction chemotherapy 40 (38%) of the patients had a reduction in left ventricular ejection fraction (LVEF), Fourteen had a decrease of 20% or greater and two were mildly symptomatic from CHF. There was additional reduction in the LVEF after HDC with a median value for LVEF of 59% (range, 20-78%). During HDC 10 patients developed clinical signs of congestive heart failure (CHF), Five patients responded to diuretic therapy and did not require any additional treatment, Four patients responded to vasodilation and/or digoxin with improvement in cardiac function, A clinically significant decrease in cardiac function was found in a small number of patients after induction chemotherapy and HDC with PBPCT. The majority of the patients tolerated this regimen without problems, Although there was a decline in LVEF as measured by radionuclide MUGA this did not prevent the majority of patients from proceeding with HDC.
引用
收藏
页码:1047 / 1052
页数:6
相关论文
共 20 条
[1]  
Amadori D, 1996, SEMIN ONCOL, V23, P16
[2]   CYCLOPHOSPHAMIDE PHARMACOKINETICS - CORRELATION WITH CARDIAC TOXICITY AND TUMOR RESPONSE [J].
AYASH, LJ ;
WRIGHT, JE ;
TRETYAKOV, O ;
GONIN, R ;
ELIAS, A ;
WHEELER, C ;
EDER, JP ;
ROSOWSKY, A ;
ANTMAN, K ;
FREI, E .
JOURNAL OF CLINICAL ONCOLOGY, 1992, 10 (06) :995-1000
[3]  
BEARMAN SI, 1990, BONE MARROW TRANSPL, V5, P173
[4]  
BUZDAR AU, 1995, SEMIN ONCOL, V22, P101
[5]   PACLITAXEL IN METASTATIC BREAST-CANCER - A TRIAL OF 2 DOSES BY A 3-HOUR INFUSION IN PATIENTS WITH DISEASE RECURRENCE AFTER PRIOR THERAPY WITH ANTHRACYCLINES [J].
GIANNI, L ;
MUNZONE, E ;
CAPRI, G ;
VILLANI, F ;
SPREAFICO, C ;
TARENZI, E ;
FULFARO, F ;
CARACENI, A ;
MARTINI, C ;
LAFFRANCHI, A ;
VALAGUSSA, P ;
BONADONNA, G .
JOURNAL OF THE NATIONAL CANCER INSTITUTE, 1995, 87 (15) :1169-1175
[6]   Human pharmacokinetic characterization and in vitro study of the interaction between doxorubicin and paclitaxel in patients with breast cancer [J].
Gianni, L ;
Vigano, L ;
Locatelli, A ;
Capri, G ;
Giani, A ;
Tarenzi, E ;
Bonadonna, G .
JOURNAL OF CLINICAL ONCOLOGY, 1997, 15 (05) :1906-1915
[7]   PACLITAXEL BY 3-HOUR INFUSION IN COMBINATION WITH BOLUS DOXORUBICIN IN WOMEN WITH UNTREATED METASTATIC BREAST-CANCER - HIGH ANTITUMOR EFFICACY AND CARDIAC EFFECTS IN A DOSE-FINDING AND SEQUENCE-FINDING STUDY [J].
GIANNI, L ;
MUNZONE, E ;
CAPRI, G ;
FULFARO, F ;
TARENZI, E ;
VILLANI, F ;
SPREAFICO, C ;
LAFFRANCHI, A ;
CARACENI, A ;
MARTINI, C ;
STEFANELLI, M ;
VALAGUSSA, P ;
BONADONNA, G .
JOURNAL OF CLINICAL ONCOLOGY, 1995, 13 (11) :2688-2699
[8]  
GOLDBERG MA, 1986, BLOOD, V68, P1114
[9]   CARDIAC TOXICITY OF BONE-MARROW TRANSPLANTATION - PREDICTIVE VALUE OF CARDIOLOGIC EVALUATION BEFORE TRANSPLANT [J].
HERTENSTEIN, B ;
STEFANIC, M ;
SCHMEISER, T ;
SCHOLZ, M ;
GOLLER, V ;
CLAUSEN, M ;
BUNJES, D ;
WIESNETH, M ;
NOVOTNY, J ;
KOCHS, M ;
ADAM, WE ;
HEIMPEL, H ;
ARNOLD, R .
JOURNAL OF CLINICAL ONCOLOGY, 1994, 12 (05) :998-1004
[10]  
HOLMES FA, 1993, MONOGR NATL CANCER I, V15, P161